Bill Text: NC H308 | 2015-2016 | Regular Session | Amended
Bill Title: Clarify Reasonable Health Insur/LTC Ombudsman
Spectrum: Moderate Partisan Bill (Democrat 14-3)
Status: (Passed) 2015-08-18 - Ch. SL 2015-220 [H308 Detail]
Download: North_Carolina-2015-H308-Amended.html
GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2015
H 2
HOUSE BILL 308
Senate Health Care Committee Substitute Adopted 7/21/15
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Short Title: Clarify Reasonable Health Insur/LTC Ombudsman. |
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Sponsors: |
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Referred to: |
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March 23, 2015
A BILL TO BE ENTITLED
AN ACT to amend the laws pertaining to the medical support and health insurance coverage relating to child support to align state law with federal guidelines that no longer include the provision that employer‑provided group health insurance is automatically considered "reasonable" AND TO MODIFY THE lONG‑TERM CARE OMBUDSMAN PROGRAM TO CONFORM WITH FEDERAL GUIDELINES.
The General Assembly of North Carolina enacts:
SECTION 1. G.S. 50‑13.11(a1) reads as rewritten:
"(a1) The court shall order the parent of a minor
child or other responsible party to maintain health insurance for the benefit
of the child when health insurance is available at a reasonable cost. If health
insurance is not presently available at a reasonable cost, the court shall
order the parent of a minor child or other responsible party to maintain health
insurance for the benefit of the child when health insurance becomes available
at a reasonable cost. As used in this subsection, health insurance for the
benefit of the child is considered reasonable in cost if it is
employment related or other group health insurance, regardless of service
delivery mechanism.the coverage for the child is available at a cost to
the parent that does not exceed five percent (5%) of the parent's gross income.
In applying this standard, the cost is the cost of (i) adding the child to the
parent's existing coverage, (ii) child‑only coverage, or (iii) if new
coverage must be obtained, the difference between the cost of self‑only
and family coverage. The court may require one or both parties to maintain
dental insurance."
SECTION 2. Part 14D of Chapter 143B of the General Statutes reads as rewritten:
"Part 14D. Long‑Term Care Ombudsman Program.
"§ 143B‑181.15. Long‑Term Care Ombudsman Program/Office; policy.
The General Assembly finds that a significant number of older citizens of this State reside in long‑term care facilities and are dependent on others to provide their care. It is the intent of the General Assembly to protect and improve the quality of care and life for residents through the establishment of a program to assist residents and providers in the resolution of complaints or common concerns, to promote community involvement and volunteerism in long‑term care facilities, and to educate the public about the long‑term care system. It is the further intent of the General Assembly that the Department of Health and Human Services, within available resources and pursuant to its duties under the Older Americans Act of 1965, as amended, 42 U.S.C. § 3001 et seq., and regulations promulgated thereunder, ensure that the quality of care and life for these residents is maintained, that necessary reports are made, and that, when necessary, corrective action is taken at the Department level.
"§ 143B‑181.16. Long‑Term Care Ombudsman Program/Office; definition.
Unless the content clearly requires otherwise, as used in this Article:
(1) "Long‑term care facility" means any skilled nursing facility and intermediate care facility as defined in G.S. 131A‑3(4) or any adult care home as defined in G.S. 131D‑20(2).
(1b) "Programmatic supervision" means the monitoring of the performance of the duties of the Regional Ombudsman and ensuring that the Area Agency on Aging does not have personnel policies or practices that conflict with the laws and policies governing the Ombudsman Program as performed by the State Ombudsman.
(1c) "Regional Ombudsman" means a person employed by an Area Agency on Aging who is certified and designated by the State Ombudsman to carry out the functions of the Regional Ombudsman Office established by this Article, 42 U.S.C. § 3001, et seq. and regulations promulgated thereunder.
(2) "Resident" means any person who is receiving treatment or care in any long‑term care facility.
(3) "State Ombudsman" means the State
Ombudsman as defined by the Older Americans Act of 1965, as amended, 42 U.S.C.
§ 3001 et seq., and regulations promulgated thereunder, who carries out
the duties and functions established by this ArticleArticle and 42
U.S.C. § 3001, et seq. and regulations promulgated thereunder.
(4) "Willful interference" means actions or inactions taken by an individual in an attempt to intentionally prevent, interfere with, or attempt to impede the Ombudsman or a representative of the Office from performing any of the functions, responsibilities, or duties set forth in 42 U.S.C. § 3001 et seq., and regulations promulgated thereunder.
"§ 143B‑181.17. Office of State Long‑Term Care Ombudsman Program/Office; establishment.
The Secretary of Department of Health and Human Services
shall establish and maintain the Office of State Long‑Term Ombudsman in
the Division of Aging. The Office shall carry out the functions and duties
required by the Older Americans Act of 1965, as amended.amended, and
as set forth in 42 U.S.C. § 3001 et seq. and regulations promulgated thereunder.
This Office shall be headed by a State Ombudsman who is a person qualified by
training and with experience in geriatrics and long‑term care. The
Attorney General shall provide legal staff and advice to this Office.
"§ 143B‑181.18. Office of State Long‑Term Care Ombudsman Program/State Ombudsman duties.
The State Ombudsman shall:shall perform the duties
provided below:
(1) Promote community involvement with long‑term
care providers and residents of long‑term care facilities and serve as
liaison between residents, residents' families, facility personnel, and
facility administration;administration.
(2) Supervise the Long‑Term Care Program pursuant
to rules adopted by the Secretary of the Department of Health and Human
Services pursuant to G.S. 143B‑10;G.S. 143B‑10.
(3) Certify regional ombudsmen. Certification
requirements shall include an internship, training in the aging process,
complaint resolution, long‑term care issues, mediation techniques, recruitment
and training of volunteers, and relevant federal, State, and local laws,
policies, and standards;standards.
(3a) Designate certified Regional Ombudsmen as representatives of the State Ombudsman Office as well as refuse, suspend, or remove designation as a representative of the Office in accordance with the Office of the State Ombudsman Policies and Procedures.
(4) Attempt to resolve complaints made by or on behalf
of individuals who are residents of long‑term care facilities, which
complaints relate to administrative action that may adversely affect the
health, safety, or welfare of residents;residents.
(5) Provide training and technical assistance to
regional ombudsmen;ombudsmen.
(6) Establish procedures for appropriate access by
regional ombudsmen to long‑term care facilities and residents' records
files, records, and other information, including procedures to
protect the confidentiality of these recordsfiles, records, and other
information and to ensure that the identity of any complainant or resident
will not be disclosed except as permitted under the Older Americans Act of
1965, as amended, 42 U.S.C. § 3001 et seq. and regulations promulgated
thereunder.
(7) Analyze data relating to complaints and conditions
in long‑term care facilities to identify significant problems and
recommend solutions;solutions.
(8) Prepare an annual report containing data and
findings regarding the types of problems experienced and complaints reported by
residents as well as recommendations for resolutions of identified long‑term
care issues;issues.
(9) Prepare findings regarding public education and
community involvement efforts and innovative programs being provided in long‑term
care facilities; andfacilities.
(10) Provide information to public agencies, and through the State Ombudsman, to legislators, and others regarding problems encountered by residents or providers as well as recommendations for resolution.
(11) Provide leadership for statewide systems advocacy efforts of the Office on behalf of long‑term care residents, including independent determinations and positions that shall not be required to represent the position of the State agency or other agency within which the Ombudsman Program is organizationally located. Provide coordination of systems advocacy efforts with representatives of the Office as outlined in Ombudsman Policies and Procedures.
(12) To the extent required to meet the requirement of the Older Americans Act and regulations promulgated thereunder regarding allotments for Vulnerable Elder Rights Protection Activities, the State Ombudsman and representatives of the Office are excluded from any State lobbying prohibitions under requirements to conduct systems advocacy on behalf of long‑term care residents.
(13) Determine the use of the fiscal resources appropriated or otherwise available for the operations of the Office, including approval of allocations provided for local program budgets that are consistent with laws, policies, and procedures governing the Ombudsman Program.
"§ 143B‑181.19. Office of Regional Long‑Term Care Ombudsman; Regional Ombudsman; duties.
(a) An Office of Regional Ombudsman Program shall be
established in each of the Area Agencies on Aging, and shall be headed by a designated
Regional Ombudsman who shall carry out the functions and duties of the
Office. The State Long‑Term Care Ombudsman shall designate all
Regional Ombudsmen housed within the Area Agency. The Area AgencyAgencies
on Aging administration shall provide administrative supervision to each
Regional Ombudsman. Ombudsman limited to the Agency's personnel
policies pertaining to time and attendance, benefits, assigned work space and
equipment, and general operations of the Agency. The State Ombudsman shall
ensure that the Area Agency does not have personnel policies or practices that
conflict with the laws and policies governing the Ombudsman Program.
(b) Pursuant to policies and procedures established by
the State Office of Long‑Term Care Ombudsman, thea Regional
Ombudsman shall:
(1) Promote community involvement with long‑term care facilities and residents of long‑term care facilities and serve as a liaison between residents, residents' families, facility personnel, and facility administration;
(2) Receive and attempt to resolve complaints made by or on behalf of residents in long‑term care facilities;
(3) Collect data about the number and types of complaints handled;
(4) Work with long‑term care providers to resolve issues of common concern;
(5) Work with long‑term care providers to promote increased community involvement;
(6) Offer assistance to long‑term care providers in staff training regarding residents' rights;
(7) Report regularly to the office of State Ombudsman about the data collected and about the activities of the Regional Ombudsman;
(8) Provide training and technical assistance to the community advisory committees; and
(9) Provide information to the general public on long‑term
care issues.issues and with the authorization of the Office of the
State Long‑Term Care Ombudsman conduct systems advocacy activities on
behalf of long‑term care residents.
"§ 143B‑181.20. State/Regional Long‑Term Care Ombudsman; authority to enter; cooperation of government agencies; communication with residents.
(a) The State and Regional Ombudsman may enter any
long‑term care facility at any time during regular visiting hours or
at any other time when access may be required by the circumstances to be
investigated, and may have reasonable access to any resident in the reasonable
pursuit of his function. The Ombudsman may communicate privately and
confidentially with residents of the facility individually or in groups. The
Ombudsman shall have access to the patient recordsresident's files,
records, and other information as permitted under the Older Americans Act
of 1965, as amended, 42 U.S.C. § 3001 et seq., and regulations promulgated
thereunder, and under procedures established by the State Ombudsman
pursuant to G.S. 143B‑181.18(6). Entry shall be conducted in a
manner that will not significantly disrupt the provision of nursing or other
care to residents and if the long‑term care facility requires
registration of all visitors entering the facility, then the State or Regional
Ombudsman must also register. Any State or Regional Ombudsman who discloses any
information obtained from the patient's resident's records except
as permitted under the Older Americans Act of 1965, as amended, 42 U.S.C. §
3001 et seq., and regulations promulgated thereunder, is guilty of a
Class 1 misdemeanor.
(b) The State or Regional Ombudsman shall identify himself as such to the resident, and the resident has the right to refuse to communicate with the Ombudsman.
(c) The resident has the right to participate in planning any course of action to be taken on his behalf by the State or Regional Ombudsman, and the resident has the right to approve or disapprove any proposed action to be taken on his behalf by the Ombudsman.
(d) The State or Regional Ombudsman shall meet with the facility administrator or person in charge before any action is taken to allow the facility the opportunity to respond, provide additional information, or take appropriate action to resolve the concern.
(e) The State and Regional Ombudsman may obtain from any government agency, and this agency shall provide, that cooperation, assistance, services, data, and access to files and records that will enable the Ombudsman to properly perform his duties and exercise his powers, provided this information is not privileged by law.
(f) If the subject of the complaint involves
suspected abuse, neglect, or exploitation, the State or Regional
Ombudsman shall only with the written informed consent of the resident or
authorization by the State Ombudsman notify the county department of
social services' Adult Protection Services section of the county department
of social services, pursuant toservices. Except as provided herein,
the State or Regional Ombudsman is not subject to the reporting requirements of
Article 6 of Chapter 108A of the General Statutes.
"§ 143B‑181.21. State/Regional Long‑Term Care Ombudsman; resolution of complaints.
(a) Following receipt of a complaint, the State or
Regional Ombudsman shall attempt to resolve the complaint using, whenever
possible, informal techniquetechniques of mediation,
conciliation, and persuasion.
(b) Complaints or conditions adversely affecting residents of long‑term care facilities that cannot be resolved in the manner described in subsection (a) of this section shall be referred by the State or Regional Ombudsman to the appropriate licensure agency pursuant to G.S. 131E‑100 through 110 and Part 1 of Article 1 of Chapter 131D of the General Statutes.
"§ 143B‑181.22. State/Regional Long‑Term Care Ombudsman; confidentiality.
The identity of any complainant, resident on whose behalf a complaint is made, or any individual providing information on behalf of the resident or complainant relevant to the attempted resolution of the complaint along with the files, records, and other information produced by the process of complaint resolution is confidential and shall be disclosed only as permitted under the Older Americans Act of 1965, as amended, 42 U.S.C. § 3001 et seq.
"§ 143B‑181.23. State/Regional Long‑Term Care Ombudsman; prohibition of retaliation.
No person shall discriminate or retaliate in any manner against any resident or relative or guardian of a resident, any employee of a long‑term care facility, or any other person because of the making of a complaint or providing of information in good faith to the State Ombudsman or Regional Ombudsman. The State Ombudsman shall determine instances of discrimination or retaliation and assess a monetary penalty in the amount of two thousand five hundred dollars ($2,500) per incident. The Department shall adopt rules pertaining to this determination of discrimination or retaliation.
"§ 143B‑181.24. Office of State/Regional Long‑Term Care Ombudsman; immunity from liability.
No representative of the Office shall be liable for good faith performance of official duties.
"§ 143B‑181.25. Office of State/Regional Long‑Term Care Ombudsman; penalty for willful interference.
Willful or unnecessary obstruction with the State or Regional
Long‑Term Care Ombudsman in the performance of his official duties is a
Class 1 misdemeanor.misdemeanor and subject to a fine of two thousand
five hundred dollars ($2,500)."
SECTION 3. Sections 1 and 3 of this act are effective when this act becomes law and apply to orders issued or agreements entered into on or after that date. Section 2 of this act becomes effective July 1, 2016.
