MISSOURI
The governor and legislative leaders in Missouri focused on nursing home reform in 2002 and 2003 to improve quality of care for residents. Their recommendations included greater penalties for infractions and more extensive disclosure and reporting requirements, coupled with eased regulations for facilities that provide quality care.
Nursing Homes
In December 2002, Governor Bob Holden called for sweeping reforms in Missouri laws to protect nursing home residents through a proposed Senior Care and Protection Act. His recommendations included the following.
- Toughening the state's neglect statute to make it easier for the Department of Health and Senior Services to bar individuals who have abused, neglected or financially exploited elders from working in the elder care industry.
- Strengthening civil penalties for poor performance.
- Rewarding nursing homes that consistently provide quality care by reducing red tape for them.
- Requiring nursing home executives to certify the quality of care they provide in their facilities.
- Expanding the statute of limitations from 180 days to two years for initiating complaints that a nursing home resident's rights were violated.
In late February 2003, Republican and Democratic legislative leaders joined to outline measures to improve quality of care in nursing homes. The bill that was enacted on April 30 (SB 556) increases penalties for all violations of nursing home care standards, which Missouri lawmakers said was the first penalty increase in more than 20 years. For the most serious violations, nursing homes could face penalties of as much as $10,000 per day. Any administrator who fails to report abuse or neglect that could result in serious injury to a resident can be charged with a Class D felony. The bill also directs that revenue generated by the fines be used for other programs to help elderly people, including the Meals-on-Wheels program and the Nursing Facility Quality of Care Fund.
The bill also requires more thorough background checks of some nursing home employees and gives state regulators greater access to nursing home records and facilities and the authority to suspend the licenses of nursing homes that refuse entry to inspectors. Nursing homes that provide quality care would be subject to fewer inspections.
The state Supreme Court in December 2002 upheld Governor Holden's action in May, cutting almost $21 million in special nursing home grants. The governor's move was part of a package of spending cuts to balance the state's budget. The state constitution allows governors to withhold appropriated money when revenues fall below projections that are used to develop the budget. Nursing homes argued that revenue for their particular appropriation had not fallen short of projections, but the court held the nursing home grants were part of the state's general revenue, which had fallen short.
Long-Term Care Insurance
The General Assembly substantially amended the Long-Term Care Insurance Act in 2002. The law requires the insurer of a long-term care contract to state clearly in its enrollment materials whether the contract is intended to be tax-qualified and to state in the policy summary whether an inflation protection option is available under the policy. The issuers also must offer a nonforfeiture benefit and provide a written explanation for a denial of coverage within 60 days.
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