660.050. Division of aging created--duties--inspectors of nursing homes, training and continuing education requirements--promulgation of rules, procedure--dementia-specific training requirements estab
Division of aging created--duties--inspectors of nursing homes,training and continuing education requirements--promulgation ofrules, procedure--dementia-specific training requirementsestablished.
660.050. 1. The "Division of Aging" is hereby transferred from thedepartment of social services to the department of health and senior servicesby a type I transfer as defined in the Omnibus State Reorganization Act of1974. The division shall aid and assist the elderly and low-incomehandicapped adults living in the state of Missouri to secure and maintainmaximum economic and personal independence and dignity. The division shallregulate adult long-term care facilities pursuant to the laws of this stateand rules and regulations of federal and state agencies, to safeguard thelives and rights of residents in these facilities.
2. In addition to its duties and responsibilities enumerated pursuant toother provisions of law, the division shall:
(1) Serve as advocate for the elderly by promoting a comprehensive,coordinated service program through administration of Older Americans Act(OAA) programs (Title III) P.L. 89-73, (42 U.S.C. 3001, et seq.), as amended;
(2) Assure that an information and referral system is developed andoperated for the elderly, including information on the Missouri care optionsprogram;
(3) Provide technical assistance, planning and training to local areaagencies on aging;
(4) Contract with the federal government to conduct surveys of long-termcare facilities certified for participation in the Title XVIII program;
(5) Serve as liaison between the department of health and seniorservices and the Federal Health Standards and Quality Bureau, as well as theMedicare and Medicaid portions of the United States Department of Health andHuman Services;
(6) Conduct medical review (inspections of care) activities such asutilization reviews, independent professional reviews, and periodic medicalreviews to determine medical and social needs for the purpose of eligibilityfor Title XIX, and for level of care determination;
(7) Certify long-term care facilities for participation in the Title XIXprogram;
(8) Conduct a survey and review of compliance with P.L. 96-566 Sec.505(d) for Supplemental Security Income recipients in long-term carefacilities and serve as the liaison between the Social Security Administrationand the department of health and senior services concerning SupplementalSecurity Income beneficiaries;
(9) Review plans of proposed long-term care facilities before they areconstructed to determine if they meet applicable state and federalconstruction standards;
(10) Provide consultation to long-term care facilities in all areasgoverned by state and federal regulations;
(11) Serve as the central state agency with primary responsibility forthe planning, coordination, development, and evaluation of policy, programs,and services for elderly persons in Missouri consistent with the provisions ofsubsection 1 of this section and serve as the designated state unit on aging,as defined in the Older Americans Act of 1965;
(12) With the advice of the governor's advisory council on aging,develop long-range state plans for programs, services, and activities forelderly and handicapped persons. State plans should be revised annually andshould be based on area agency on aging plans, statewide priorities, and stateand federal requirements;
(13) Receive and disburse all federal and state funds allocated to thedivision and solicit, accept, and administer grants, including federal grants,or gifts made to the division or to the state for the benefit of elderlypersons in this state;
(14) Serve, within government and in the state at large, as an advocatefor elderly persons by holding hearings and conducting studies orinvestigations concerning matters affecting the health, safety, and welfare ofelderly persons and by assisting elderly persons to assure their rights toapply for and receive services and to be given fair hearings when suchservices are denied;
(15) Provide information and technical assistance to the governor'sadvisory council on aging and keep the council continually informed of theactivities of the division;
(16) After consultation with the governor's advisory council on aging,make recommendations for legislative action to the governor and to the generalassembly;
(17) Conduct research and other appropriate activities to determine theneeds of elderly persons in this state, including, but not limited to, theirneeds for social and health services, and to determine what existing servicesand facilities, private and public, are available to elderly persons to meetthose needs;
(18) Maintain and serve as a clearinghouse for up-to-date informationand technical assistance related to the needs and interests of elderly personsand persons with Alzheimer's disease or related dementias, includinginformation on the Missouri care options program, dementia-specific trainingmaterials and dementia-specific trainers. Such dementia-specific informationand technical assistance shall be maintained and provided in consultation withagencies, organizations and/or institutions of higher learning with expertisein dementia care;
(19) Provide area agencies on aging with assistance in applying forfederal, state, and private grants and identifying new funding sources;
(20) Determine area agencies on aging annual allocations for Title XXand Title III of the Older Americans Act expenditures;
(21) Provide transportation services, home-delivered and congregatemeals, in-home services, counseling and other services to the elderly andlow-income handicapped adults as designated in the Social Services Block GrantReport, through contract with other agencies, and shall monitor such agenciesto ensure that services contracted for are delivered and meet standards ofquality set by the division;
(22) Monitor the process pursuant to the federal PatientSelf-determination Act, 42 U.S.C. 1396a (w), in long-term care facilities bywhich information is provided to patients concerning durable powers ofattorney and living wills.
3. The division director, subject to the supervision of the director ofthe department of health and senior services, shall be the chiefadministrative officer of the division and shall exercise for the division thepowers and duties of an appointing authority pursuant to chapter 36, RSMo, toemploy such administrative, technical and other personnel as may be necessaryfor the performance of the duties and responsibilities of the division.
4. The division may withdraw designation of an area agency on aging onlywhen it can be shown the federal or state laws or rules have not been compliedwith, state or federal funds are not being expended for the purposes for whichthey were intended, or the elderly are not receiving appropriate serviceswithin available resources, and after consultation with the director of thearea agency on aging and the area agency board. Withdrawal of any particularprogram of services may be appealed to the director of the department ofhealth and senior services and the governor. In the event that the divisionwithdraws the area agency on aging designation in accordance with the OlderAmericans Act, the division shall administer the services to clientspreviously performed by the area agency on aging until a new area agency onaging is designated.
5. Any person hired by the department of health and senior servicesafter August 13, 1988, to conduct or supervise inspections, surveys orinvestigations pursuant to chapter 198, RSMo, shall complete at least onehundred hours of basic orientation regarding the inspection process andapplicable rules and statutes during the first six months of employment. Anysuch person shall annually, on the anniversary date of employment, present tothe department evidence of having completed at least twenty hours ofcontinuing education in at least two of the following categories:communication techniques, skills development, resident care, or policy update. The department of health and senior services shall by rule describe thecurriculum and structure of such continuing education.
6. The division may issue and promulgate rules to enforce, implement andeffectuate the powers and duties established in this section and sections198.070 and 198.090, RSMo, and sections 660.250 and 660.300 to 660.320. Anyrule or portion of a rule, as that term is defined in section 536.010, RSMo,that is created under the authority delegated in this section shall becomeeffective only if it complies with and is subject to all of the provisions ofchapter 536, RSMo, and, if applicable, section 536.028, RSMo. This sectionand chapter 536, RSMo, are nonseverable and if any of the powers vested withthe general assembly pursuant to chapter 536, RSMo, to review, to delay theeffective date or to disapprove and annul a rule are subsequently heldunconstitutional, then the grant of rulemaking authority and any rule proposedor adopted after August 28, 2001, shall be invalid and void.
7. Missouri care options is a program, operated and coordinated by thedivision of aging, which informs individuals of the variety of care optionsavailable to them when they may need long-term care.
8. The division shall, by January 1, 2002, establish minimumdementia-specific training requirements for employees involved in the deliveryof care to persons with Alzheimer's disease or related dementias who areemployed by skilled nursing facilities, intermediate care facilities,residential care facilities*, agencies providing in-home care servicesauthorized by the division of aging, adult day-care programs, independentcontractors providing direct care to persons with Alzheimer's disease orrelated dementias and the division of aging. Such training shall beincorporated into new employee orientation and ongoing in-service curriculafor all employees involved in the care of persons with dementia. Thedepartment of health and senior services shall, by January 1, 2002, establishminimum dementia-specific training requirements for employees involved in thedelivery of care to persons with Alzheimer's disease or related dementias whoare employed by home health and hospice agencies licensed by chapter 197,RSMo. Such training shall be incorporated into the home health and hospiceagency's new employee orientation and ongoing in-service curricula for allemployees involved in the care of persons with dementia. The dementiatraining need not require additional hours of orientation or ongoingin-service. Training shall include at a minimum, the following:
(1) For employees providing direct care to persons with Alzheimer'sdisease or related dementias, the training shall include an overview ofAlzheimer's disease and related dementias, communicating with persons withdementia, behavior management, promoting independence in activities of dailyliving, and understanding and dealing with family issues;
(2) For other employees who do not provide direct care for, but may havedaily contact with, persons with Alzheimer's disease or related dementias, thetraining shall include an overview of dementias and communicating with personswith dementia.
As used in this subsection, the term "employee" includes persons hired asindependent contractors. The training requirements of this subsection shallnot be construed as superceding any other laws or rules regardingdementia-specific training.
(L. 1984 H.B. 1131 § 2, A.L. 1988 S.B. 602, A.L. 1992 S.B. 573 & 634, A.L. 1993 S.B. 52, A.L. 1994 H.B. 1335 & 1381, A.L. 1995 H.B. 409 merged with S.B. 445 merged with S.B. 3, A.L. 2001 H.B. 603)*Revisor's note: The term "residential care facilities" may include "assisted living facilities", see section 198.005 regarding changes to name reference.
(1997) Amendments to this section contained in 1995 CCS HB 409 declared unconstitutional pursuant to sections 21 and 23 of article III of the Missouri Constitution. Missouri Health Care Association v. Attorney General of the State of Missouri, 953 S.W.2d 617 (Mo.banc).