Bill Text: NC H308 | 2015-2016 | Regular Session | Chaptered
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-Chaptered.html
GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2015
SESSION LAW 2015-220
HOUSE BILL 308
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 has personnel policies and procedures consistent 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 as required by 42 U.S.C. § 3001 et seq. and regulations promulgated thereunder.
"§ 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 Agency Agencies on Aging administration shall
provide administrative supervision to only personnel management for each
Regional Ombudsman. Ombudsman in accordance with personnel policies
and procedures of the Agency that are consistent with federal and State
Ombudsman law and policy. 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 Department 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.
In the General Assembly read three times and ratified this the 10th day of August, 2015.
s/ Louis M. Pate, Jr.
Deputy President Pro Tempore of the Senate
s/ Tim Moore
Speaker of the House of Representatives
s/ Pat McCrory
Governor
Approved 2:18 p.m. this 18th day of August, 2015
