DAR File No. 27692

Health, Health Systems Improvement, Licensing

R432-270-10

Admissions

NOTICE OF PROPOSED RULE

DAR File No.: 27692
Filed: 02/02/2005, 03:05
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

In November 2003, the Health Facility Committee reviewed the number of variances issued for residents receiving Hospice Services in Assisted Living Facilities. The majority of the variances were issued since the residents no longer had a stable health condition, although most were still able to evacuate the building with little or no assistance. Based on the number of variances, it is proposed to add to the rule conditions whereby facilities may retain these residents without the need to request a Department variance.

Summary of the rule or change:

This change amends the admission criteria for assisted living facilities to allow hospice residents to stay in the facilities without submitting a variance application.

State statutory or constitutional authorization for this rule:

Sections 26-21-1 and 26-21-5

Anticipated cost or savings to:

the state budget:

The estimated savings is $3,060 per year to the Department. This is figured by calculating the number of variances issued and the time it takes for each one to be processed.

local governments:

No effect on local government. The rule changes only affect state requirements and do not affect any local requirements or other health programs.

other persons:

The Department estimates cost savings in time to assisted living providers who will not have to use staff time to submit variance applications for hospice residents. This will save approximately $5,100 in staff time to assisted living facilities per year. There will be no loss of revenue to nursing facilities because this process has been in assisted living for the last nine years. The residents in assisted living will not see any cost savings from this rule change.

Compliance costs for affected persons:

There are no anticipated costs for any parties as a result of this rulemaking. This rulemaking will alleviate requirements for providers and streamline a process that has been in effect for nine years.

Comments by the department head on the fiscal impact the rule may have on businesses:

The fiscal impact on Assisted Living Facilities is expected to be positive by avoiding the need to apply for variances. Comments from nursing homes have been sought. This rule mirrors current practice and should not have a major fiscal impact on the operation of any providers. Fiscal impact will be reevaluated based on public comments received. David N. Sundwall, MD

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Direct questions regarding this rule to:

Joel Hoffman at the above address, by phone at 801-538-6165, by FAX at 801-538-6163, or by Internet E-mail at jhoffman@utah.gov

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

03/31/2005

This rule may become effective on:

04/01/2005

Authorized by:

David N. Sundwall, Executive Director

RULE TEXT

R432. Health, Health Systems Improvement, Licensing.

R432-270. Assisted Living Facilities.

R432-270-10. Admissions.

(1) The facility shall have written admission, retention, and transfer policies that are available to the public upon request.

(2) Before accepting a resident, the facility must obtain sufficient information about the person's ability to function in the facility through the following:

(a) an interview with the resident and the resident's responsible person; and

(b) the completion of the resident assessment.

(3) If the Department determines during inspection or interview that the facility knowingly and willfully admits or retains residents who do not meet license criteria, then the Department may, for a time period specified, require that resident assessments be conducted by an individual who is independent from the facility.

(4) The facility shall accept and retain only residents who meet the following criteria:

(a) Residents admitted to a Type I facility shall meet the following criteria before being admitted:

(i) be ambulatory or mobile and be capable of taking life saving action in an emergency;

(ii) have stable health;

(iii) require no assistance or only limited assistance in the activities of daily living; and

(iv) require and receive intermittent care or treatment in the facility from a licensed health care professional either through contract or by the facility, if permitted by facility policy.

(b) Residents admitted to a Type II facility may be independent and semi-independent, but shall not be dependent.

(5) Type I and Type II assisted living facilities shall not admit or retain a person who:

(a) manifests behavior that is suicidal, sexually or socially inappropriate, assaultive, or poses a danger to self or others; or

(b) has active tuberculosis or other chronic communicable diseases that cannot be treated in the facility or on an outpatient basis; or may be transmitted to other residents or guests through the normal course of activities; or

(c) requires inpatient hospital or long-term nursing care.

(6) A Type I facility may accept or retain residents who:

(a) do not require significant assistance during night sleeping hours;

(b) are able to take life saving action in an emergency without the assistance of another person; [or]and

(c) do not require significant assistance from staff or others with more than two ADL's.

(7) A Type II facility may accept or retain residents who require significant assistance from staff or others in more than two ADL's, provided the staffing level and coordinated supportive health and social services meet the needs of the resident.

(8) The prospective resident or the prospective resident's responsible person must sign a written admission agreement prior to admission. The admission agreement shall be kept on file by the facility and shall specify at least the following:

(a) room and board charges and charges for basic and optional services;

(b) provision for a 30-day notice prior to any change in established charges;

(c) admission, retention, transfer, discharge, and eviction policies;

(d) conditions under which the agreement may be terminated;

(e) the name of the responsible party;

(f) notice that the Department has the authority to examine resident records to determine compliance with licensing requirements; and

(g) refund provisions that address the following:

(i) thirty-day notices for transfer or discharge given by the facility or by the resident,

(ii) emergency transfers or discharges,

(iii) transfers or discharges without notice, and

(iv) the death of a resident.

(9) A type I assisted living facility may accept and retain residents who have been admitted to a hospice program, under the following conditions:

(a) hospice residents comprise no more than 25 percent of the facility's resident census.

(b) the facility keeps a copy of the physician's diagnosis and orders for care;

(c) the facility makes the hospice services part of the resident's service plan which shall explain who is responsible to meet the resident's needs; and

(d) if a resident is admitted to a hospice program and is no longer capable of exiting the facility without assistance and the facility wants to retain the resident in the facility, the facility must:

(i) submit a Request for Agency Action Variance Application to the Department; and

(ii) ensure that the an individual capable of assisting the resident to exit the facility in an emergency is with the resident 24 hours a day, seven days a week.

(10) A type II assisted living facility may accept and retain residents who have been admitted to a hospice program, under the following conditions:

(a) hospice residents comprise no more than 25 percent of the facility's resident census.

(b) the facility keeps a copy of the physician's diagnosis and orders for care;

(c) the facility makes the hospice services part of the resident's service plan which shall explain who is responsible to meet the resident's needs; and

(d) if a resident becomes dependent while on hospice care and the facility wants to retain the resident in the facility, the facility must:

(i) develop an emergency plan to evacuate the hospice resident in the event of an emergency; and

(ii) integrate the emergency plan into the resident's service plan.

KEY: health facilities

[May 26, 2004]2005

Notice of Continuation January 31, 2005

26-21-1

26-21-5

ADDITIONAL INFORMATION

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For questions regarding the content or application of this rule, please contact Joel Hoffman at the above address, by phone at 801-538-6165, by FAX at 801-538-6163, or by Internet E-mail at jhoffman@utah.gov

For questions about the rulemaking process, please contact the Division of Administrative Rules (801-538-3764). Please Note: The Division of Administrative Rules is NOT able to answer questions about the content or application of these administrative rules.