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| THE GENERAL ASSEMBLY OF PENNSYLVANIA |
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| HOUSE BILL |
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| INTRODUCED BY GINGRICH, BEYER, CARROLL, FRANKEL, GEIST, GROVE, HENNESSEY, HESS, HORNAMAN, KAUFFMAN, KORTZ, MILLER, MOUL, PHILLIPS, PICKETT, RAPP, ROSS, SIPTROTH, SWANGER, VULAKOVICH AND WATSON, FEBRUARY 9, 2009 |
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| REFERRED TO COMMITTEE ON AGING AND OLDER ADULT SERVICES, FEBRUARY 9, 2009 |
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| AN ACT |
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1 | Establishing the Long-Term Care Quality Improvement Council; and |
2 | providing for a system for data collection, for benchmarking |
3 | and dissemination of long-term care provider quality |
4 | performance reports, for annual reports to the General |
5 | Assembly and for publication of reports for public use. |
6 | TABLE OF CONTENTS |
7 | Chapter 1. General Provisions |
8 | Section 101. Short title. |
9 | Section 102. Legislative findings. |
10 | Section 103. Definitions. |
11 | Chapter 3. Long-Term Care Quality Improvement Council |
12 | Section 301. Establishment. |
13 | Section 302. Powers and duties. |
14 | Section 303. Commonwealth agency responsibilities. |
15 | Chapter 5. Miscellaneous Provisions |
16 | Section 501. Administration. |
17 | Section 502. Repeals. |
18 | Section 503. Effective date. |
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1 | The General Assembly of the Commonwealth of Pennsylvania |
2 | hereby enacts as follows: |
3 | CHAPTER 1 |
4 | GENERAL PROVISIONS |
5 | Section 101. Short title. |
6 | This act shall be known and may be cited as the Long-Term |
7 | Care Quality Improvement Act. |
8 | Section 102. Legislative findings. |
9 | The General Assembly finds and declares as follows: |
10 | (1) This Commonwealth has the third oldest population |
11 | demographically of any state, with more than 1.9 million |
12 | residents who are at least 65 years of age and will |
13 | increasingly demand more intensive long-term care services. |
14 | Currently, approximately 77,500 older Pennsylvanians reside |
15 | in nursing facilities; approximately 53,000 reside in |
16 | personal care homes or assisted living residences; at least |
17 | 20,000 Pennsylvanians reside in independent housing |
18 | environments; and thousands more receive long-term care and |
19 | services in their homes and in community settings. |
20 | (2) For the forseeable future, the needs of |
21 | Pennsylvanians for long-term care will continue to increase |
22 | substantially and the peak post-World War II baby boom |
23 | population will reach retirement age beginning in 2010. |
24 | (3) As this Commonwealth's population continues to age, |
25 | the number of impairments of daily living activities among |
26 | citizens requiring long-term care will also continue to |
27 | increase, thereby posing greater challenges to all providers |
28 | of long-term care. |
29 | (4) The Commonwealth should respond to the demographic |
30 | and health care challenges it faces by becoming the nation's |
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1 | leader in providing and assuring high-quality long-term care |
2 | services. |
3 | (5) While the enforcement of licensing requirements |
4 | through inspections and a system of reasonable and |
5 | proportionate sanctions is necessary to establish and |
6 | maintain minimum standards for long-term care in order to |
7 | promote excellence in long-term care, the focus of the |
8 | Commonwealth's efforts should be expanded to prioritize the |
9 | development of programs to continuously promote systemic |
10 | improvement in the quality of long-term care. |
11 | (6) The establishment of a comprehensive consumer |
12 | information system that makes readily available comparative |
13 | information regarding long-term care providers, services |
14 | provided and a quantifiable and reliable performance |
15 | measurement system that links standards and modalities for |
16 | the provision of care to actual outcomes will allow consumers |
17 | and their family members to make more informed choices and |
18 | promote continuous systemic improvements in the quality of |
19 | long-term care and services. |
20 | (7) An effective performance measurement system should |
21 | be developed in cooperation with consumers, family members, |
22 | providers, regulators and payers to provide specific |
23 | benchmarks to compare various care settings and include not |
24 | only clinical outcomes, but also managerial and operational |
25 | practices. |
26 | (8) The Department of Health's clinical best-management |
27 | practices research project has successfully facilitated a |
28 | comparison between good and average nursing facilities and |
29 | promoted improvements and innovations with respect to the |
30 | quality of services provided by nursing facilities. |
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1 | (9) The project should be substantially expanded to |
2 | include all settings and modalities in which long-term care |
3 | is provided and continuously improved. Additional resources |
4 | should be devoted to research needed to validate the |
5 | clinical, operational and managerial practices that are truly |
6 | superior and meaningfully contribute to a higher quality of |
7 | care and a better quality of life for older Pennsylvanians. |
8 | Section 103. Definitions. |
9 | The following words and phrases when used in this act shall |
10 | have the meanings given to them in this section unless the |
11 | context clearly indicates otherwise: |
12 | "Benchmarks." Combinations of measures relating to long-term |
13 | care providers, including evaluations of services provided, |
14 | compliance history, best-management practices and outcome-based |
15 | performance measures, developed as voluntary consensus standards |
16 | and verified based upon research and evaluation, that are |
17 | associated with providing various levels of quality of care |
18 | suitable for the management of particular conditions, diseases |
19 | or disabilities for which long-term care is necessary and |
20 | appropriate. |
21 | "Best practices." Clinical, operational and managerial- |
22 | related practices that promote the provision of high-quality |
23 | long-term care. |
24 | "Commonwealth agency." An agency of the Commonwealth |
25 | responsible for the licensing, registration, certification, |
26 | inspection and investigation of long-term care providers, |
27 | including, but not limited to, the Department of Aging, the |
28 | Department of Health, the Insurance Department and the |
29 | Department of Public Welfare. |
30 | "Intra-governmental council." The Intra-Governmental Council |
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1 | on Long-Term Care established under section 212 of the act of |
2 | June 13, 1967 (P.L.31, No.21), known as the Public Welfare Code. |
3 | "Long-term care." Assistance, services or devices provided |
4 | over an extended period of time and designed to meet medical, |
5 | personal and social needs associated with aging, chronic disease |
6 | or disability, acute illness or injury or behavioral health |
7 | problems that enable a person to live as independently as |
8 | possible, which services are provided by a nursing facility, |
9 | assisted living facility, domiciliary care home, personal care |
10 | home, continuing care retirement community, home health agency, |
11 | adult day-care provider or other home-based and community-based |
12 | provider. |
13 | "Long-term care provider." An entity licensed, certified or |
14 | approved by a Commonwealth agency to provide long-term care. |
15 | "Performance measures." A system composed of processes and |
16 | outcome measures of performance, processes for collecting, |
17 | analyzing and disseminating these measures from multiple sources |
18 | or organizations and an automated database, which together can |
19 | be used to facilitate performance improvement of long-term care |
20 | providers under this act. |
21 | "Quality improvement council." The Long-Term Care Quality |
22 | Improvement Council established in section 301. |
23 | "Voluntary consensus standards." Nonbinding standards for |
24 | performance developed through a process comparable to procedures |
25 | used to develop standards, under section 2(b)(10) of the |
26 | National Institute of Standards and Technology Act (31 Stat. |
27 | 1449, 15 U.S.C. § 272(b)(10)), involving consultation with |
28 | consumers, family members, regulators and long-term care |
29 | providers, validated on clinical research and subject to regular |
30 | and periodic review and modification as necessary to |
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1 | continuously seek improvements in the quality of long-term care. |
2 | CHAPTER 3 |
3 | LONG-TERM CARE QUALITY IMPROVEMENT COUNCIL |
4 | Section 301. Establishment. |
5 | (a) General rule.--The Long-Term Care Quality Improvement |
6 | Council is established as an independent council. The quality |
7 | improvement council shall be affiliated with and provided with |
8 | administrative support and legal services by the intra- |
9 | governmental council and may take action jointly in cooperation |
10 | with the intra-governmental council. |
11 | (b) Composition.--The quality improvement council shall |
12 | consist of the following members: |
13 | (1) The Secretary of Aging. |
14 | (2) The Secretary of Health. |
15 | (3) The Secretary of Public Welfare. |
16 | (4) The Secretary of Labor and Industry. |
17 | (5) The Insurance Commissioner. |
18 | (6) The Physician General. |
19 | (7) Eight residents of this Commonwealth who represent |
20 | long-term care providers, two of whom shall be appointed by |
21 | the President pro tempore of the Senate, two of whom shall be |
22 | appointed by the Minority Leader of the Senate, two of whom |
23 | shall be appointed by the Speaker of the House of |
24 | Representatives and two of whom shall be appointed by the |
25 | Minority Leader of the House of Representatives. Those |
26 | appointed by the legislative officers shall include a |
27 | representative of the proprietary nursing facilities, |
28 | nonprofit nursing facilities, county-owned nursing |
29 | facilities, hospital-based nursing facilities, personal care |
30 | homes, assisted living facilities, continuing care retirement |
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1 | communities and home health agencies. |
2 | (8) Three members who are affiliated with Commonwealth |
3 | university-based research organizations with a purpose of |
4 | determining the components or factors that serve |
5 | appropriately as the indicators of quality care in long-term |
6 | care, one of whom shall be appointed by the Governor, one of |
7 | whom shall be appointed by the President pro tempore of the |
8 | Senate and one of whom shall be appointed by the Speaker of |
9 | the House of Representatives. |
10 | (9) Two physicians who practice in long-term care |
11 | settings, one of whom shall practice in a facility-based |
12 | setting and the other of whom shall practice in a community |
13 | setting and both of whom shall be appointed by the Governor |
14 | from a list of at least four qualified individuals |
15 | recommended by the Pennsylvania Medical Directors |
16 | Association. |
17 | (10) Two licensed nurses with a minimum of five years' |
18 | experience practicing in a long-term care provider setting |
19 | and currently employed by a long-term care provider, one of |
20 | whom is employed in a facility-based setting and the other of |
21 | whom is employed in a community setting, both of whom shall |
22 | be appointed by the Governor. |
23 | (11) Two residents of this Commonwealth who either: |
24 | (i) receive or formerly received long-term care, one |
25 | of whom resides in a facility-based setting and the other |
26 | of whom resides in a community setting; or |
27 | (ii) are family members of past or current |
28 | recipients of long-term care in such setting and who are |
29 | not health care workers nor representatives of a consumer |
30 | advocacy group, whether paid or unpaid; |
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1 | both of whom shall be appointed by the Governor. |
2 | (c) Chairperson and vice chairperson.--The members of the |
3 | quality improvement council shall annually elect, by a majority |
4 | vote of the members, a chairperson and vice chairperson from |
5 | among the members who do not serve in an ex officio capacity. |
6 | (d) Bylaws.--The quality improvement council shall adopt |
7 | bylaws, not inconsistent with this act, and may appoint such |
8 | committees or elect such officers subordinate to those provided |
9 | for in subsection (c) as it deems advisable. |
10 | (e) Professional advisory group.--The quality improvement |
11 | council shall appoint a professional advisory group that shall, |
12 | on an ad hoc basis, respond to issues presented to it by the |
13 | quality improvement council members or committees and shall make |
14 | recommendations to the quality improvement council. |
15 | (f) Compensation and expenses.--The members of the quality |
16 | improvement council and the professional advisory group shall |
17 | not receive a salary or per diem allowance for serving in that |
18 | capacity but shall be reimbursed for actual and necessary |
19 | expenses incurred in the performance of their duties, including |
20 | reimbursement of travel and living expenses while engaged in |
21 | business of the quality improvement council. |
22 | (g) Terms.--The terms of the Secretary of Aging, the |
23 | Secretary of Health, the Secretary of Public Welfare, the |
24 | Secretary of Labor and Industry, the Insurance Commissioner and |
25 | the Physician General shall be concurrent with their holding of |
26 | public office, and the other members shall each serve for a term |
27 | of three years and continue to serve until their successor is |
28 | appointed. |
29 | (h) Vacancies.--Vacancies on the quality improvement council |
30 | shall be filled in the same manner in which they were originally |
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1 | designated under subsection (b) within 60 days of the vacancy, |
2 | except that appointments to fill vacancies under subsection (b) |
3 | (7) shall be made from among the same class or category of long- |
4 | term care providers as the immediate successor of the appointee, |
5 | except as otherwise agreed upon by the appointing authorities in |
6 | the event that two or more vacancies are filled at the same |
7 | time. |
8 | (i) Quorum.--Twelve members, a majority of which shall be |
9 | made up of representatives appointed under subsection (b) (7), |
10 | shall constitute a quorum for the transaction of any business, |
11 | and the act by the majority of the members present at any |
12 | meeting in which there is a quorum shall be deemed to be the act |
13 | of the quality improvement council. Notwithstanding any other |
14 | provision of law, the transaction of any business by the quality |
15 | improvement council at a meeting shall be made either by the |
16 | members present in person or through use of amplified telephonic |
17 | equipment if authorized by the bylaws of the council. |
18 | (j) Meetings.--The quality improvement council shall meet at |
19 | least quarterly and at the call of the chairperson or as may be |
20 | provided in the bylaws under subsection (d). |
21 | Section 302. Powers and duties. |
22 | (a) General powers.--The quality improvement council shall |
23 | exercise all powers necessary and appropriate to carry out its |
24 | duties, including the following: |
25 | (1) To employ an executive director and other staff as |
26 | necessary to implement this act and to fix their compensation |
27 | and duties. Employees of the quality improvement council |
28 | shall be deemed employees of the Commonwealth for all |
29 | purposes. |
30 | (2) To apply for, solicit, receive, establish priorities |
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1 | for, allocate, disburse, contract for and administer funds, |
2 | including appropriations, grants, gifts and bequests, that |
3 | are made available to the quality improvement council from |
4 | any source consistent with the purposes of this act. |
5 | (3) To make and execute contracts and other instruments |
6 | and engage professional consultants as necessary to implement |
7 | this act under the procedures set forth in 62 Pa.C.S. Pt. I |
8 | (relating to Commonwealth Procurement Code). |
9 | (4) To conduct examinations, investigations and audits |
10 | and to hear testimony and take proof under oath or |
11 | affirmation at public or private hearings on any matter |
12 | necessary to its duties. |
13 | (b) Rules and regulations.--The quality improvement council |
14 | may, in the manner provided by law, promulgate rules and |
15 | regulations necessary to carry out its duties under this act, |
16 | including rules and regulations relating to: |
17 | (1) The establishment of a methodology to collect, |
18 | analyze and disseminate data reflecting provider quality and |
19 | service effectiveness and to continuously study quality of |
20 | care. |
21 | (2) The submission of health care information by long- |
22 | term care providers to the quality improvement council as |
23 | necessary to evaluate provider quality and service |
24 | effectiveness and to continuously study the quality of care. |
25 | Any documents, materials, records, information or other raw |
26 | data submitted by a long-term care provider shall be deemed |
27 | confidential by the quality improvement council and shall not |
28 | be discoverable or admissible as evidence in any civil or |
29 | administrative action or proceeding in the same manner as |
30 | provided by section 311 of the act of March 20, 2002 (P.L. |
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1 | 154, No.13), known as the Medical Care Availability and |
2 | Reduction of Error (Mcare) Act, and shall not be made |
3 | available to any person or agency, other than the quality |
4 | improvement council, except reports regarding the overall |
5 | quality of long-term care with the expressed written consent |
6 | of the providers. |
7 | (3) The quality improvement council shall have the |
8 | authority to independently audit information submitted by |
9 | data sources as needed to corroborate the accuracy of the |
10 | data, provided that audits shall be coordinated, to the |
11 | extent practical, with other audits performed by or on behalf |
12 | of the Commonwealth. |
13 | (c) Development of voluntary consensus standards.--In |
14 | accordance with the provisions set forth in 62 Pa.C.S. Pt. I, |
15 | the quality improvement council shall contract with an |
16 | independent, qualified, experienced and nationally recognized |
17 | entity qualified to develop, implement and continuously update |
18 | and revise voluntary consensus standards for long-term care |
19 | providers to do all of the following: |
20 | (1) Provide comprehensive comparative information |
21 | regarding the characteristics of long-term care providers and |
22 | services provided by them, including, but not limited to, |
23 | information relating to location, capacity, staffing, methods |
24 | of payment accepted and the availability of financial |
25 | assistance. |
26 | (2) Provide comprehensive comparative information |
27 | regarding the quality of care services provided by long-term |
28 | care providers. |
29 | (3) Identify, evaluate and promote the adoption of best |
30 | practices for long-term care providers and provide |
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1 | comprehensive comparative information regarding the |
2 | utilization of best practices by long-term care providers. |
3 | (4) Identify and validate performance measures for the |
4 | evaluation of the quality of long-term care and provide |
5 | comprehensive comparative information regarding the quality |
6 | of long-term care offered by long-term care providers based |
7 | upon such performance measures. |
8 | (5) Provide information for long-term care providers, |
9 | which benchmarks combine information relating to the |
10 | characteristics, services, compliance history, adoption of |
11 | best practices and quality of care as determined by |
12 | performance measures, for use in a rating system that will |
13 | assist consumers and family members in making informed |
14 | choices for obtaining long-term care. |
15 | (6) Provide a comprehensive comparative information |
16 | system that is readily available to consumers, their family |
17 | members and the general public without cost both through |
18 | publications and Internet access regarding long-term care |
19 | providers and that assists in the selection and utilization |
20 | of long-term care and services. |
21 | (7) Provide recommendations to the quality improvement |
22 | council for long-term care policies, practices and procedures |
23 | that may be instituted for the purposes of enhancing and |
24 | improving the quality of long-term care provided. |
25 | (8) Establish annual quality improvement goals for long- |
26 | term care facilities in this Commonwealth. |
27 | (d) Annual report to the General Assembly.--The quality |
28 | improvement council shall issue a report no later than December |
29 | 31, 2009, and annually thereafter, to the General Assembly and |
30 | the public regarding its activities during the preceding year. |
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1 | The report shall be made available without cost both through |
2 | publication and Internet access and shall include: |
3 | (1) A schedule of the year's meetings. |
4 | (2) A list of contracts entered into by the quality |
5 | improvement council and amounts awarded to each contractor. |
6 | (3) Financial information regarding funding received and |
7 | expenditures undertaken by the quality improvement council |
8 | and amounts awarded to each contractor. |
9 | (4) A summary of data collected regarding the |
10 | characteristics and services provided by long-term care |
11 | providers, adoption of best practices and achievement of |
12 | quality based on performance measures. |
13 | (5) The status of development, implementation, use and |
14 | improvement in the comprehensive comparative consumer |
15 | information system as provided by subsection (c)(6). |
16 | (6) Recommendations for long-term care policies, |
17 | practices and procedures that may be voluntarily adopted by |
18 | long-term care providers to enhance and improve the quality |
19 | of long-term care. |
20 | (7) Recommendations for statutory or regulatory changes |
21 | to improve long-term care provider quality performance. |
22 | Section 303. Commonwealth agency responsibilities. |
23 | (a) General rule.--Each Commonwealth agency responsible for |
24 | the regulation of long-term care providers or the development of |
25 | policies regarding long-term care shall: |
26 | (1) Receive and review reports of trends identified in |
27 | the analysis of performance measures under section 302. |
28 | (2) In conjunction with the quality improvement council, |
29 | analyze and evaluate existing regulations and approve |
30 | recommendations issued by the quality improvement council |
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1 | under section 302(d)(7). |
2 | (b) Implementation of recommendations.--Recommendations made |
3 | by the quality improvement council to providers under section |
4 | 302(d)(6) regarding practices and procedures for the improvement |
5 | of the quality of care may not be considered for the purposes of |
6 | long-term care provider licensure, registration or certification |
7 | by a Commonwealth agency and may not be considered mandatory |
8 | standards of care for statutory or regulatory purposes or in |
9 | civil or criminal litigation. |
10 | CHAPTER 5 |
11 | MISCELLANEOUS PROVISIONS |
12 | Section 501. Administration. |
13 | (a) Access to council data.--Except as otherwise provided by |
14 | this act, information and data received by the quality |
15 | improvement council or its professional consultants may be |
16 | disseminated and published and shall be made available, used and |
17 | protected from unauthorized disclosure and shall not be subject |
18 | to disclosure under the act of June February 14, 2008 (P.L.6, |
19 | No.3), known as the Right-to-Know Law. |
20 | (b) Enforcement.--The quality improvement council shall have |
21 | standing to bring an action in law or in equity through legal |
22 | counsel as provided by the Governor's Office of General Counsel |
23 | in a court of competent jurisdiction to enforce compliance with |
24 | any requirement of this act, including regulations adopted under |
25 | this act. |
26 | (c) Antitrust.--A person or entity that submits or receives |
27 | data or information under this act or receives data or |
28 | information from the quality improvement council or its |
29 | professional consultants in accordance with this act are |
30 | declared to be acting under Commonwealth requirements embodied |
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1 | in this act and shall be exempt from antitrust claims or actions |
2 | grounded upon the submission or receipt of such data or |
3 | information. |
4 | Section 502. Repeals. |
5 | All acts and parts of acts are repealed insofar as they are |
6 | inconsistent with this act. |
7 | Section 503. Effective date. |
8 | This act shall take effect in 180 days. |
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