SECOND REGULAR SESSION
94TH GENERAL ASSEMBLY
INTRODUCED BY REPRESENTATIVE BRUNS.
Pre-filed January 2, 2008 and copies ordered printed.
D. ADAM CRUMBLISS, Chief Clerk
AN ACT
To repeal sections 192.925, 197.500, 198.006, 198.070, 198.090, 198.532, 208.909, 208.912, 208.915, 210.900, 210.906, 210.933, 565.180, 565.182, 565.184, 565.188, 565.200, 660.010, 660.050, 660.053, 660.054, 660.055, 660.057, 660.058, 660.060, 660.062, 660.067, 660.069, 660.070, 660.099, 660.250, 660.255, 660.260, 660.261, 660.263, 660.265, 660.270, 660.275, 660.280, 660.285, 660.290, 660.295, 660.300, 660.305, 660.310, 660.315, 660.317, 660.320, 660.321, 660.400, 660.403, 660.405, 660.407, 660.409, 660.411, 660.414, 660.416, 660.418, 660.420, 660.512, 660.620, 660.625, 660.600, 660.603, 660.605, and 660.608, RSMo, and to enact in lieu thereof fifty-nine new sections relating to protections for senior citizens, disabled persons, and children, with penalty provisions.
Be it enacted by the General Assembly of the state of Missouri, as follows:
Section A. Sections 192.925, 197.500, 198.006, 198.070, 198.090, 198.532, 208.909, 208.912, 208.915, 210.900, 210.906, 210.933, 565.180, 565.182, 565.184, 565.188, 565.200, 660.010, 660.050, 660.053, 660.054, 660.055, 660.057, 660.058, 660.060, 660.062, 660.067, 660.069, 660.070, 660.099, 660.250, 660.255, 660.260, 660.261, 660.263, 660.265, 660.270, 660.275, 660.280, 660.285, 660.290, 660.295, 660.300, 660.305, 660.310, 660.315, 660.317, 660.320, 660.321, 660.400, 660.403, 660.405, 660.407, 660.409, 660.411, 660.414, 660.416, 660.418, 660.420, 660.512, 660.620, 660.625, 660.600, 660.603, 660.605, and 660.608, RSMo, are repealed and fifty-nine new sections enacted in lieu thereof, to be known as sections 192.925, 192.2000, 192.2001, 192.2003, 192.2006, 192.2009, 192.2012, 192.2015, 192.2025, 192.2030, 192.2033, 192.2035, 192.2040, 192.2100, 192.2103, 192.2106, 192.2109, 192.2112, 192.2115, 192.2118, 192.2121, 192.2124, 192.2127, 192.2130, 192.2150, 192.2153, 192.2175, 192.2178, 192.2181, 192.2184, 192.2187, 192.2200, 192.2203, 192.2206, 192.2209, 192.2212, 192.2215, 192.2218, 192.2221, 192.2224, 192.2227, 192.2250, 192.2253, 198.006, 198.090, 198.532, 198.700, 198.703, 198.705, 198.708, 208.909, 210.900, 210.906, 565.180, 565.182, 565.184, 565.188, 565.200, and 660.010, to read as follows:
192.925. 1. To increase public awareness of the problem of elder abuse and neglect and financial exploitation of the elderly, the department of health and senior services shall implement an education and awareness program. Such program shall have the goal of reducing the incidences of elder abuse and neglect and financial exploitation of the elderly, and may focus on:
(1) The education and awareness of mandatory reporters on their responsibility to report elder abuse and neglect and financial exploitation of the elderly;
(2) Targeted education and awareness for the public on the problem, identification and reporting of elder abuse and neglect and financial exploitation of the elderly;
(3) Publicizing the elder abuse and neglect hot line telephone number;
(4) Education and awareness for law enforcement agencies and prosecutors on the problem and identification of elder abuse and neglect and financial exploitation of the elderly, and the importance of prosecuting cases pursuant to chapter 565, RSMo; and
(5) Publicizing the availability of background checks prior to hiring an individual for caregiving purposes.
2. The department of social services and facilities licensed pursuant to chapters 197 and 198, RSMo, shall cooperate fully with the department of health and senior services in the distribution of information pursuant to this program.
[660.050.] 192.2000. 1. The "Division of Aging" is hereby transferred from the department of social services to the department of health and senior services by a type I transfer as defined in the Omnibus State Reorganization Act of 1974. All references in the revised statutes of Missouri to the division of aging shall include any division or divisions established by the department as a successor division or divisions to the division of aging. The division shall aid and assist the elderly and low-income [handicapped] adults with disabilities living in the state of Missouri to secure and maintain maximum economic and personal independence and dignity. The division shall regulate adult long-term care facilities pursuant to the laws of this state and rules and regulations of federal and state agencies, to safeguard the lives and rights of residents in these facilities.
2. In addition to its duties and responsibilities enumerated pursuant to other provisions of law, the division shall:
(1) Serve as advocate for the elderly by promoting a comprehensive, coordinated service program through administration of Older Americans Act (OAA) programs (Title III) P.L. 89-73, (42 U.S.C. 3001, et seq.), as amended;
(2) Assure that an information and referral system is developed and operated for the elderly, including information on the Missouri care options program;
(3) Provide technical assistance, planning and training to local area agencies on aging;
(4) Contract with the federal government to conduct surveys of long-term care facilities certified for participation in the Title XVIII program;
(5) Serve as liaison between the department of health and senior services and the Federal Health Standards and Quality Bureau, as well as the Medicare and Medicaid portions of the United States Department of Health and Human Services;
(6) Conduct medical review (inspections of care) activities such as utilization reviews, independent professional reviews, and periodic medical reviews to determine medical and social needs for the purpose of eligibility for Title XIX, and for level of care determination;
(7) Certify long-term care facilities for participation in the Title XIX program;
(8) Conduct a survey and review of compliance with P.L. 96-566 Sec. 505(d) for Supplemental Security Income recipients in long-term care facilities and serve as the liaison between the Social Security Administration and the department of health and senior services concerning Supplemental Security Income beneficiaries;
(9) Review plans of proposed long-term care facilities before they are constructed to determine if they meet applicable state and federal construction standards;
(10) Provide consultation to long-term care facilities in all areas governed by state and federal regulations;
(11) Serve as the central state agency with primary responsibility for the planning, coordination, development, and evaluation of policy, programs, and services for elderly persons in Missouri consistent with the provisions of subsection 1 of this section and serve as the designated state unit on aging, as defined in the Older Americans Act of 1965;
(12) With the advice of the governor's advisory council on aging, develop long-range state plans for programs, services, and activities for elderly [and handicapped] persons and long-term care options for elderly persons and adults with disabilities. State plans should be revised annually and should be based on area agency on aging plans, statewide priorities, and state and federal requirements;
(13) Receive and disburse all federal and state funds allocated to the division and solicit, accept, and administer grants, including federal grants, or gifts made to the division or to the state for the benefit of elderly persons in this state;
(14) Serve, within government and in the state at large, as an advocate for elderly persons by holding hearings and conducting studies or investigations concerning matters affecting the health, safety, and welfare of elderly persons and by assisting elderly persons to assure their rights to apply for and receive services and to be given fair hearings when such services are denied;
(15) Provide information and technical assistance to the governor's advisory council on aging and keep the council continually informed of the activities of the division;
(16) After consultation with the governor's advisory council on aging, make recommendations for legislative action to the governor and to the general assembly;
(17) Conduct research and other appropriate activities to determine the needs of elderly persons in this state, including, but not limited to, their needs for social and health services, and to determine what existing services and facilities, private and public, are available to elderly persons to meet those needs;
(18) Maintain [and serve as a clearinghouse for] information regarding resources that provide up-to-date information and technical assistance related to the needs and interests of elderly persons and persons with Alzheimer's disease or related dementias, including information on the Missouri care options program, dementia-specific training materials and dementia-specific trainers. Such dementia-specific information and technical assistance shall be [maintained and] provided in consultation with agencies, organizations and/or institutions of higher learning with expertise in dementia care;
(19) Provide area agencies on aging with assistance in applying for federal, state, and private grants and identifying new funding sources;
(20) Determine area agencies on aging annual allocations for Title XX and Title III of the Older Americans Act expenditures;
(21) Provide transportation services, home-delivered and congregate meals, in-home services, counseling and other services to the elderly and low-income [handicapped] adults with disabilities as designated in the Social Services Block Grant Report, through contract with other agencies, and shall monitor such agencies to ensure that services contracted for are delivered and meet standards of quality set by the division;
(22) Monitor the process pursuant to the federal Patient Self-determination Act, 42 U.S.C. 1396a (w), in long-term care facilities by which information is provided to patients concerning durable powers of attorney and living wills.
3. The division director, subject to the supervision of the director of the department of health and senior services, shall be the chief administrative officer of the division and shall exercise for the division the powers and duties of an appointing authority pursuant to chapter 36, RSMo, to employ such administrative, technical and other personnel as may be necessary for the performance of the duties and responsibilities of the division.
4. The division may withdraw designation of an area agency on aging only when it can be shown the federal or state laws or rules have not been complied with, state or federal funds are not being expended for the purposes for which they were intended, or the elderly are not receiving appropriate services within available resources, and after consultation with the director of the area agency on aging and the area agency board. Withdrawal of any particular program of services may be appealed to the director of the department of health and senior services and the governor. In the event that the division withdraws the area agency on aging designation in accordance with the Older Americans Act, the division shall administer the services to clients previously performed by the area agency on aging until a new area agency on aging is designated.
5. Any person hired by the department of health and senior services after August 13, 1988, to conduct or supervise inspections, surveys or investigations pursuant to chapter 198, RSMo, shall complete at least one hundred hours of basic orientation regarding the inspection process and applicable rules and statutes during the first six months of employment. Any such person shall annually, on the anniversary date of employment, present to the department evidence of having completed at least twenty hours of continuing education in at least two of the following categories: communication techniques, skills development, resident care, or policy update.
The department of health and senior services shall by rule describe the curriculum and structure of such continuing education.
6. The division may issue and promulgate rules to enforce, implement and effectuate the powers and duties established in this section [and sections 198.070 and 198.090, RSMo, and sections 660.250 and 660.300 to 660.320] , section 192.2100, sections 192.2175 to 192.2187, and section 198.090, RSMo. Any rule or portion of a rule, as that term is defined in section 536.010, RSMo, that is created under the authority delegated in this section shall become effective only if it complies with and is subject to all of the provisions of chapter 536, RSMo, and, if applicable, section 536.028, RSMo. This section and chapter 536, RSMo, are nonseverable and if any of the powers vested with the general assembly pursuant to chapter 536, RSMo, to review, to delay the effective date or to disapprove and annul a rule are subsequently held unconstitutional, then the grant of rulemaking authority and any rule proposed or adopted after August 28, 2001, shall be invalid and void.
7. Missouri care options is a program, operated and coordinated by the [division of aging] department, which informs individuals of the variety of care options available to them when they may need long-term care.
8. The division shall, by January 1, 2002, establish minimum dementia-specific training requirements for employees involved in the delivery of care to persons with Alzheimer's disease or related dementias who are employed by skilled nursing facilities, intermediate care facilities, residential care facilities, agencies providing in-home care services authorized by the [division of aging] department, adult day-care programs, independent contractors providing direct care to persons with Alzheimer's disease or related dementias and the [division of aging] department. Such training shall be incorporated into new employee orientation and ongoing in-service curricula for all employees involved in the care of persons with dementia. The department of health and senior services shall, by January 1, 2002, establish minimum dementia-specific training requirements for employees involved in the delivery of care to persons with Alzheimer's disease or related dementias who are employed by home health and hospice agencies licensed by chapter 197, RSMo. Such training shall be incorporated into the home health and hospice agency's new employee orientation and ongoing in-service curricula for all employees involved in the care of persons with dementia. The dementia training need not require additional hours of orientation or ongoing in-service. Training shall include at a minimum, the following:
(1) For employees providing direct care to persons with Alzheimer's disease or related dementias, the training shall include an overview of Alzheimer's disease and related dementias, communicating with persons with dementia, behavior management, promoting independence in activities of daily living, and understanding and dealing with family issues;
(2) For other employees who do not provide direct care for, but may have daily contact with, persons with Alzheimer's disease or related dementias, the training shall include an overview of dementias and communicating with persons with dementia.
As used in this subsection, the term "employee" includes persons hired as independent contractors. The training requirements of this subsection shall not be construed as superceding any other laws or rules regarding dementia-specific training.
9. All powers, duties, and functions of the board of nursing home administrators contained in chapter 344, RSMo, are transferred by type I transfer to the department of health and senior services. The public members of the board shall be appointed by the director of the department of health and senior services.
[660.060.] 192.2001. All authority, powers, duties, functions, records, personnel, property, contracts, budgets, matters pending and other pertinent vestiges of the division of aging shall be transferred to the department of health and senior services.
[660.053.] 192.2003. As used in [section 199.025, RSMo, and sections 660.050 to 660.057 and 660.400 to 660.420] sections 192.2000 to 192.2040 and sections 192.2200 to 192.2227, the following terms mean:
(1) "Area agency on aging", the agency designated by the division in a planning and service area to develop and administer a plan and administer available funds for a comprehensive and coordinated system of services for the elderly and persons with disabilities who require similar services;
(2) "Area agency board", the local policy-making board which directs the actions of the area agency on aging under state and federal laws and regulations;
(3) "Department", the department of health and senior services;
(4) "Director", the director of the [division of aging of the Missouri] department of [social] health and senior services, or the director's designee;
[(4) "Division", the division of aging of the Missouri department of social services;]
(5) "Elderly" or "elderly persons", persons who are sixty years of age or older;
(6) "Disability", a mental or physical impairment that substantially limits one or more major life activities, whether the impairment is congenital or acquired by accident, injury or disease, where such impairment is verified by medical findings;
(7) "Local government", a political subdivision of the state whose authority is general or a combination of units of general purpose local governments;
(8) "Major life activities", functions such as caring for one's self, performing manual tasks, walking, seeing, hearing, speaking, breathing, learning, and working;
(9) ["Medicaid"] "MO HealthNet", medical assistance provided under section 208.151, RSMo, et seq., in compliance with Title XIX, Public Law 89-97, 1965 amendments to the Social Security Act (42 U.S.C. 301 et seq.), as amended;
(10) "Protective services", a service provided by the [Missouri division of aging in response to the need for protection from harm or neglect to eligible adults under sections 660.250 to 660.295] state or other governmental or private organizations or individuals which are necessary for the eligible adult to meet his or her essential human needs;
(11) "Registered caregiver", a person who provides primary long-term care for an elderly person and wishes to receive information, services or support from the shared care program;
(12) "Shared care", a program administered by the [division of aging] department in which Missouri families who provide primary long-term care for an elderly person and register as a shared care member with the [division of aging] department shall receive access to certain supportive services and may receive a state tax credit;
(13) "Shared care community project", a project in a community that offers to help support shared care participation through development of programs;
(14) "Shared care member", a registered caregiver or shared care provider who registers with the [division of aging] department in order to participate in the shared care program;
(15) "Shared care provider", any state authorized long-term care provider in the state, including, but not limited to, in-home, home health, hospice, adult day care, residential care facility or assisted living facility, or nursing home, who voluntarily registers with the [division of aging] department to be available as a resource for the shared care program;
(16) "Shared care tax credit", a tax credit to registered caregivers who meet the requirements of section [660.055] 192.2009.
[660.054.] 192.2006. 1. The [division of aging of the department of social] department of health and senior services shall establish a program to help families who provide the primary long-term care for an elderly person. This program shall be known as "shared care" and has the following goals:
(1) To provide services and support for families caring for an elderly person;
(2) To increase awareness of the variety of privately funded services which may be available to those persons caring for an elderly person;
(3) To increase awareness of the variety of government services which may be available to those caring for an elderly person;
(4) Recognition on an annual basis by the governor for those families participating in the shared care program and community project groups participating in the shared care program;
(5) To provide a tax credit to members who meet the qualifications pursuant to section [660.055] 192.2009; and
(6) To promote community involvement by:
(a) Providing local communities information about the shared care program and to encourage the establishment of support groups where none are available and to support existing support groups, and other programs for shared care members and providers to share ideas, information and resources on caring for an elderly person; and
(b) Encouraging local home care, adult day care or other long-term care providers, who have regularly scheduled training sessions for paid caregivers, to voluntarily invite shared care members to participate in education and training sessions at no cost to the registered caregivers. Such providers shall not be held liable in any civil or criminal action related to or arising out of the participation or training of shared care members in such sessions.
2. To further the goals of the shared care program, the director shall:
(1) Promulgate specific rules and procedures for the shared care program. Any rule or portion of a rule, as that term is defined in section 536.010, RSMo, that is created under the authority delegated in sections [660.050 to 660.057] 192.2000 to 192.2012 shall become effective only if it complies with and is subject to all of the provisions of chapter 536, RSMo, and, if applicable, section 536.028, RSMo. All rulemaking authority delegated prior to August 28, 1999, is of no force and effect and repealed. Nothing in this section shall be interpreted to repeal or affect the validity of any rule filed or adopted prior to August 28, 1999, if it fully complied with all applicable provisions of law. This section and chapter 536, RSMo, are nonseverable and if any of the powers vested with the general assembly pursuant to chapter 536, RSMo, to review, to delay the effective date or to disapprove and annul a rule are subsequently held unconstitutional, then the grant of rulemaking authority and any rule proposed or adopted after August 28, 1999, shall be invalid and void;
(2) Maintain a registry of names and addresses of shared care members and shared care providers;
(3) [Compile a list, updated annually, of] Maintain a web site with links to public and private resources, services and programs which may be available to assist and support the registered caregiver with caring for the elderly. Such [list] web site shall be [given] available to shared care members along with information on shared care providers in their community. Private organizations and providers shall be responsible for [providing] updating information to the [division of aging] department for inclusion on the [list] web site. The [division of aging] department shall establish reporting procedures for private organizations and publicly disseminate the [division's] department's guidelines statewide;
(4) [Compile and distribute to shared care members] Post shared care member's information on the Internet regarding resources that contain information about [the] services and benefits of the shared care program [and a bibliography of] with links to resources and materials with information helpful to such members. The [bibliography will give members an overview] web links shall provide access to an array of available information and is not required to be comprehensive;
(5) Encourage shared care providers, consumer groups, churches and other philanthropic organizations to help local communities develop local support systems where none are available and to support existing support groups for persons caring for elderly persons and make [division] department staff available, if possible;
(6) In conjunction with the director of revenue, develop a physician certification for shared care tax credit form to be given to registered caregivers upon request. The form shall require, but is not limited to:
(a) Identifying information about the registered caregiver for tax purposes, and the signature of the registered caregiver certifying that he or she qualifies for the shared care tax credit as provided in section [660.055] 192.2009;
(b) Identifying information about the elderly person receiving care for verification purposes;
(c) Identifying information about and the signature of the physician licensed pursuant to the provisions of chapter 334, RSMo, for verification and certification purposes;
(d) A description by such physician of the physical or mental condition of the elderly person that makes them incapable of living alone and lists the care, assistance with daily living and oversight needed at home in order to prevent placement in a facility licensed pursuant to chapter 198, RSMo; and
(e) A complete explanation of the shared care tax credit and its guidelines and directions on completion of the form and how to file for the shared care tax credit with the department of revenue; and
(7) In conjunction with the director of revenue, develop a [division of aging] department certification for shared care tax credit form to be given at the request of the registered caregivers when a [division of aging] department assessment has been completed for other purposes. The form shall require, but is not limited to:
(a) Identifying information about the registered caregiver for tax purposes, and the signature of the registered caregiver certifying that he or she qualifies for the shared care tax credit as provided in section [660.055] 192.2009;
(b) Identifying information about the elderly person receiving care for verification purposes;
(c) Identifying information about and the signature of the [division of aging] department staff for verification and certification purposes;
(d) A description by the [division of aging] department staff of the physical or mental condition of the elderly person that makes them incapable of living alone and lists the care, assistance with daily living and oversight needed at home in order to prevent placement in a facility licensed pursuant to chapter 198, RSMo; and
(e) A complete explanation of the shared care tax credit and its guidelines and directions for completing the form and how to file for the shared care tax credit with the department of revenue.
3. Funds appropriated for the shared care program shall be appropriated to and administered by the department of [social] health and senior services.
[660.055.] 192.2009. 1. Any registered caregiver who meets the requirements of this section shall be eligible for a shared care tax credit in an amount not to exceed five hundred dollars to defray the cost of caring for an elderly person. In order to be eligible for a shared care tax credit, a registered caregiver shall:
(1) Care for an elderly person, age sixty or older, who:
(a) Is physically or mentally incapable of living alone, as determined and certified by his or her physician licensed pursuant to chapter 334, RSMo, or by the [division of aging] department staff when an assessment has been completed for the purpose of qualification for other services; and
(b) Requires assistance with activities of daily living to the extent that without care and oversight at home would require placement in a facility licensed pursuant to chapter 198, RSMo; and
(c) Under no circumstances, is able or allowed to operate a motor vehicle; and
(d) Does not receive funding or services through [Medicaid] MO HealthNet or social services block grant funding;
(2) Live in the same residence to give protective oversight for the elderly person meeting the requirements described in subdivision (1) of this subsection for an aggregate of more than six months per tax year;
(3) Not receive monetary compensation for providing care for the elderly person meeting the requirements described in subdivision (1) of this subsection; and
(4) File the original completed and signed physician certification for shared care tax credit form or the original completed and signed [division of aging] department certification for shared care tax credit form provided for in subsection 2 of section [660.054] 192.2006 along with such caregiver's Missouri individual income tax return to the department of revenue.
2. The tax credit allowed by this section shall apply to any year beginning after December 31, 1999.
3. Any rule or portion of a rule, as that term is defined in section 536.010, RSMo, that is created under the authority delegated in sections [660.050 to 660.057] 192.2000 to 192.2012 shall become effective only if it complies with and is subject to all of the provisions of chapter 536, RSMo, and, if applicable, section 536.028, RSMo. All rulemaking authority delegated prior to August 28, 1999, is of no force and effect and repealed. Nothing in this section shall be interpreted to repeal or affect the validity of any rule filed or adopted prior to August 28, 1999, if it fully complied with all applicable provisions of law. This section and chapter 536, RSMo, are nonseverable and if any of the powers vested with the general assembly pursuant to chapter 536, RSMo, to review, to delay the effective date or to disapprove and annul a rule are subsequently held unconstitutional, then the grant of rulemaking authority and any rule proposed or adopted after August 28, 1999, shall be invalid and void.
4. Any person who knowingly falsifies any document required for the shared care tax credit shall be subject to the same penalties for falsifying other tax documents as provided in chapter 143, RSMo.
[660.057.] 192.2012. 1. On and after August 13, 1984, an area agency on aging shall operate with local administrative responsibility for Title III of the Older Americans Act, and other funds allocated to it by the [division] department. The area agency board shall be responsible for all actions of an area agency on aging in its jurisdiction, including, but not limited to, the accountability for funds and compliance with federal and state laws and rules. Such responsibility shall include all geographic areas in which the area agency on aging is designated to operate. The respective area agency board shall appoint a director of the area agency on aging in its jurisdiction. [Beginning January 1, 1995,] The director of the area agency on aging shall submit an annual performance report to the [division] department director, the speaker of the house of representatives, the president pro tempore of the senate and the governor. Such performance report shall give a detailed accounting of all funds which were available to and expended by the area agency on aging from state, federal and private sources.
2. Each area agency on aging shall have an area agency on aging advisory council, which shall:
(1) Recommend basic policy guidelines for the administration of the activities of the area agencies on aging on behalf of elderly persons and advise the area agency on aging on questions of policy;
(2) Advise the area agency on aging with respect to the development of the area plan and budget, and review and comment on the completed area plan and budget before its transmittal to the [division] department;
(3) Review and evaluate the effectiveness of the area agency on aging in meeting the needs of elderly persons in the planning and service area;
(4) Meet at least quarterly, with all meetings being subject to sections 610.010 to 610.030, RSMo.
3. Each area agency board shall:
(1) Conduct local planning functions for Title III and Title XX, and such other funds as may be available;
(2) Develop a local plan for service delivery, subject to review and approval by the [division] department, that complies with federal and state requirements and in accord with locally determined objectives consistent with the state policy on aging;
(3) Assess the needs of elderly persons within the planning and service delivery area for service for social and health services, and determine what resources are currently available to meet those needs;
(4) Assume the responsibility of determining services required to meet the needs of elderly persons, assure that such services are provided within the resources available, and determine when such services are no longer needed;
(5) Endeavor to coordinate and expand existing resources in order to develop within its planning and service area a comprehensive and coordinated system for the delivery of social and health services to elderly persons;
(6) Serve as an advocate within government and within the community at large for the interests of elderly persons within its planning and service area;
(7) Make grants to or enter into contracts with any public or private agency for the provision of social or health services not otherwise sufficiently available to elderly persons within the planning and service area;
(8) Monitor and evaluate the activities of its service providers to ensure that the services being provided comply with the terms of the grant or contract. Where a provider is found to be in breach of the terms of its grant or contract, the area agency shall enforce the terms of the grant or contract;
(9) Conduct research, evaluation, demonstration or training activities appropriate to the achievement of the goal of improving the quality of life for elderly persons within its planning and service area;
(10) Comply with [division] department requirements that have been developed in consultation with the area agencies for client and fiscal information, and provide to the [division] department information necessary for federal and state reporting, program evaluation, program management, fiscal control and research needs.
4. [Beginning January 1, 1995,] The records of each area agency on aging shall be audited at least every other year. All audits required by the Older Americans Act of 1965, as amended, shall satisfy this requirement.
[660.058.] 192.2015. 1. The [division of aging] department shall provide budget allotment tables to each area agency on aging by January first of each year. Each area agency on aging shall submit its area plan, area budget and service contracts to the [division of aging] department by March first of each year. Each April, the area agencies on aging shall present their plans to the [division of aging] department in a public hearing scheduled by the [division] department and held in the area served by the area agency on aging. Within thirty days of such hearing, the [division] department shall report findings and recommendations to the board of directors for the area agency on aging, the area agency on aging advisory council, the members of the senate budget committee and the members of the house appropriations committee for social services and corrections.
2. Each area agency on aging shall include in its area plan performance measures and outcomes to be achieved for each year covered by the plan. Such measures and outcomes shall also be presented to the [division] department during the public hearing.
3. The [division of aging] department shall conduct on-site monitoring of each area agency on aging at least once a year. The [division of aging] department shall send all monitoring reports to the area agency on aging advisory council and the board of directors for the area agency which is the subject of the reports.
[660.062.] 192.2025. 1. There is hereby created a "State Board of Senior Services" which shall consist of seven members, who shall be appointed by the governor, by and with the advice and consent of the senate. No member of the state board of senior services shall hold any other office or employment under the state of Missouri other than in a consulting status relevant to the member's professional status, licensure or designation. Not more than four of the members of the state board of senior services shall be from the same political party.
2. Each member shall be appointed for a term of four years; except that of the members first appointed, two shall be appointed for a term of one year, two for a term of two years, two for a term of three years and one for a term of four years. The successors of each shall be appointed for full terms of four years. No person may serve on the state board of senior services for more than two terms. The terms of all members shall continue until their successors have been duly appointed and qualified. One of the persons appointed to the state board of senior services shall be a person currently working in the field of gerontology. One of the persons appointed to the state board of senior services shall be a physician with expertise in geriatrics. One of the persons appointed to the state board of senior services shall be a person with expertise in nutrition. One of the persons appointed to the state board of senior services shall be a person with expertise in rehabilitation services of persons with disabilities. One of the persons appointed to the state board of senior services shall be a person with expertise in mental health issues. In making the two remaining appointments, the governor shall give consideration to individuals having a special interest in gerontology or disability-related issues, including senior citizens. Four of the seven members appointed to the state board of senior services shall be members of the governor's advisory council on aging. If a vacancy occurs in the appointed membership, the governor may appoint a member for the remaining portion of the unexpired term created by the vacancy. The members shall receive actual and necessary expenses plus twenty-five dollars per day for each day of actual attendance.
3. The board shall elect from among its membership a chairman and a vice chairman, who shall act as chairman in his or her absence. The board shall meet at the call of the chairman. The chairman may call meetings at such times as he or she deems advisable, and shall call a meeting when requested to do so by three or more members of the board.
4. The state board of senior services shall advise the department of health and senior services in the:
(1) Promulgation of rules and regulations by the department of health and senior services;
(2) Formulation of the budget for the department of health and senior services; and
(3) Planning for and operation of the department of health and senior services.
[660.067.] 192.2030. As used in sections [660.067 to 660.070] 192.2030 to 192.2035, the following terms shall mean:
(1) "Adult day care", a group program that emphasizes appropriate services for persons eighteen years of age or older [having Alzheimer's disease and related disorders] who have functional impairments and that provides services for periods of less than twenty-four hours but more than two hours per day in a place other than the adult's home;
(2) "Alzheimer's disease and related disorders", diseases resulting from significant destruction of brain tissue and characterized by a decline of memory and other intellectual functions. These diseases include but are not limited to progressive, degenerative and dementing illnesses such as presenile and senile dementias, Alzheimer's disease and other related disorders;
(3) "Appropriate services", services that emphasize surveillance, safety, behavior management and other techniques used to assist persons having Alzheimer's disease and related disorders;
(4) "Director", the director of the division of aging of the department of [social] health and senior services, or the director's designee;
(5) ["Division", the division of aging of the department of social services;
(6)] "In-home companion", someone trained to provide appropriate services to persons having Alzheimer's disease and related disorders and who provides those services in the home;
[(7)] (6) "Respite care", a program that provides temporary and short-term residential care, sustenance, supervision and other appropriate services for persons having Alzheimer's disease and related disorders who otherwise reside in their own or in a family home.
[660.069.] 192.2033. 1. To encourage development of appropriate services for persons having Alzheimer's disease and related disorders, the [division] department may make grants to public and private entities for pilot projects from funds specifically appropriated for this purpose. Pilot projects shall have the following goals:
(1) To prevent or postpone institutionalization of persons having Alzheimer's disease and related disorders who currently live in their own home or in a family home;
(2) To offer services that emphasize safety, surveillance and behavior management rather than, or in addition to, medical treatment, homemaker, chore or personal care services;
(3) To temporarily relieve family members or others who have assumed direct care responsibilities by offering services that allow care givers to leave the home. These services shall include but not be limited to adult day care, in-home companions and respite care;
(4) To test the practical and economic feasibility of providing services in settings and at levels designed for varying needs; and
(5) To develop program models that can be adapted and operated by other public and private entities.
2. The director, in accordance with chapter 536, RSMo, shall promulgate rules that establish procedures for grant application, review, selection, monitoring and auditing of grants made [pursuant to sections 660.067 to 660.070] under this section and section 192.2035.
3. The grants shall be limited to a duration of one year but may be renewable for one additional year at the director's discretion and if funds are appropriated for this purpose.
[660.070.] 192.2035. The commissioner of administration, in consultation with the director of the [division of aging] department, shall promulgate rules that establish procedures for contracting with grantees receiving funds under [sections 660.067 to 660.070] this section and section 192.2035. No rule or portion of a rule promulgated under the authority of [sections 660.067 to 660.070] this section and section 192.2035 shall become effective unless it has been promulgated pursuant to the provisions of section 536.024, RSMo.
[660.099.] 192.2040. 1. The general assembly may appropriate funds in addition to the amount currently being provided per annum for nutrition services for the elderly. Funds so designated to provide nutrition services for the elderly shall be allocated to the [Missouri division of aging] department to be placed on the formula basis and distributed to each area agency on aging throughout the state of Missouri.
2. The general assembly may appropriate funds in addition to the amount currently being provided per annum through the Missouri elderly and handicapped transportation program. Funds so designated to provide transportation for the elderly and developmentally disabled shall be allocated to the [Missouri division of aging] department to be placed on the formula basis and distributed to each area agency on aging throughout the state of Missouri.
3. The general assembly may appropriate funds in addition to the amount currently being provided per annum for home-delivered meals for the elderly. Such additional funds shall be allocated to the [Missouri division of aging] department to be placed on the formula basis and distributed to each area agency on aging throughout the state of Missouri.
[660.250.] 192.2100. As used in sections [660.250 to 660.321] 192.2100 to 192.2130 and sections 192.2175 to 192.2187, the following terms mean:
(1) "Abuse", the infliction of physical, sexual, or emotional injury or harm including financial exploitation by any person, firm or corporation;
(2) "Court", the circuit court;
(3) "Department", the department of health and senior services;
(4) "Director", director of the department of health and senior services or his or her designees;
(5) "Eligible adult", a person sixty years of age or older who is unable to protect his or her own interests or adequately perform or obtain services which are necessary to meet his or her essential human needs or an adult with a disability, as defined in section [660.053] 192.2003, between the ages of eighteen and fifty-nine who is unable to protect his or her own interests or adequately perform or obtain services which are necessary to meet his or her essential human needs;
(6) "Home health agency", the same meaning as such term is defined in section 197.400, RSMo;
(7) "Home health agency employee", a person employed by a home health agency;
(8) "Home health patient", an eligible adult who is receiving services through any home health agency;
(9) "In-home services client", an eligible adult who is receiving services in his or her private residence through any in-home services provider agency;
(10) "In-home services employee", a person employed by an in-home services provider agency;
(11) "In-home services provider agency", a business entity under contract with the department or with a [Medicaid] MO HealthNet participation agreement, which employs persons to deliver any kind of services provided for eligible adults in their private homes;
(12) "Least restrictive environment", a physical setting where protective services for the eligible adult and accommodation is provided in a manner no more restrictive of an individual's personal liberty and no more intrusive than necessary to achieve care and treatment objectives;
(13) "Likelihood of serious physical harm", one or more of the following:
(a) A substantial risk that physical harm to an eligible adult will occur because of his or her failure or inability to provide for his or her essential human needs as evidenced by acts or behavior which has caused such harm or which gives another person probable cause to believe that the eligible adult will sustain such harm;
(b) A substantial risk that physical harm will be inflicted by an eligible adult upon himself or herself, as evidenced by recent credible threats, acts, or behavior which has caused such harm or which places another person in reasonable fear that the eligible adult will sustain such harm;
(c) A substantial risk that physical harm will be inflicted by another upon an eligible adult as evidenced by recent acts or behavior which has caused such harm or which gives another person probable cause to believe the eligible adult will sustain such harm;
(d) A substantial risk that further physical harm will occur to an eligible adult who has suffered physical injury, neglect, sexual or emotional abuse, or other maltreatment or wasting of his or her financial resources by another person;
(14) "Neglect", the failure to provide services to an eligible adult by any person, firm or corporation with a legal or contractual duty to do so, when such failure presents either an imminent danger to the health, safety, or welfare of the client or a substantial probability that death or serious physical harm would result;
(15) "Protective services", services provided by the state or other governmental or private organizations or individuals which are necessary for the eligible adult to meet his or her essential human needs.
[660.255.] 192.2103. 1. Any person having reasonable cause to suspect that an eligible adult presents a likelihood of suffering serious physical harm and is in need of protective services shall report such information to the department.
2. The report shall be made orally or in writing. It shall include, if known:
(1) The name, age, and address of the eligible adult;
(2) The name and address of any person responsible for the eligible adult's care;
(3) The nature and extent of the eligible adult's condition; and
(4) Other relevant information.
3. Reports regarding persons determined not to be eligible adults as defined in section [660.250] 192.2100 shall be referred to the appropriate state or local authorities.
4. The department shall maintain a statewide toll free phone number for receipt of reports.
5. Any person complying with this section in the making of a report or in cooperating with the department in any of its activities under sections 192.2100 to 192.2130 shall be immune from any civil or criminal liability for making such a report or in cooperating with the department, unless such person acts negligently, recklessly, in bad faith, or with malicious purpose. Any person who purposely files a false report of elder abuse or neglect is guilty of a crime under sections 565.186 and 565.188, RSMo.
[660.260.] 192.2106. 1. Upon receipt of a report, the department shall make a prompt and thorough investigation to determine whether or not an eligible adult is facing a likelihood of serious physical harm and is in need of protective services. The department shall provide for any of the following:
(1) Identification of the eligible adult and determination that the eligible adult is eligible for services;
(2) Evaluation and diagnosis of the needs of eligible adults;
(3) Provision of social casework, counseling or referral to the appropriate local or state authority;
(4) Assistance in locating and receiving alternative living arrangements as necessary;
(5) Assistance in locating and receiving necessary protective services; or
(6) The coordination and cooperation with other state agencies and public and private agencies in exchange of information and the avoidance of duplication of services.
[660.261.] 2. Upon receipt of a report that an eligible adult between the ages of eighteen and fifty-nine is facing a likelihood of serious physical harm, the department shall:
(1) Investigate or refer the report to appropriate law enforcement or state agencies; and
(2) Provide services or refer to local community or state agencies.
[660.263.] 192.2109. 1. Reports made pursuant to sections [660.250 to 660.295] 192.2100 to 192.2130 shall be confidential and shall not be deemed a public record and shall not be subject to the provisions of section 109.180, RSMo, or chapter 610, RSMo.
2. Such reports shall be accessible for examination and copying only to the following persons or offices, or to their designees:
(1) The department or any person or agency designated by the department;
(2) The attorney general;
(3) The department of mental health for persons referred to that department;
(4) Any appropriate law enforcement agency; and
(5) The eligible adult or [his] the eligible adult's legal guardian.
3. The name of the reporter shall not be disclosed unless:
(1) Such reporter specifically authorizes disclosure of [his] the reporter's name; and
(2) The department determines that disclosure of the name of the reporter is necessary in order to prevent further harm to an eligible adult.
4. Any person who violates the provisions of this section, or who permits or encourages the unauthorized dissemination of information contained in the central registry and in reports and records made pursuant to sections [660.250 to 660.295] 192.2100 to 192.2130, shall be guilty of a class A misdemeanor.
5. The department shall maintain a central registry capable of receiving and maintaining reports received in a manner that facilitates rapid access and recall of the information reported, and of subsequent investigations and other relevant information. The department shall electronically record any telephone report of suspected abuse and neglect received by the department and such recorded reports shall be retained by the department for a period of one year after recording.
6. Although reports to the central registry may be made anonymously, the department shall in all cases, after obtaining relevant information regarding the alleged abuse or neglect, attempt to obtain the name and address of any person making a report.
[660.265.] 192.2112. When an eligible adult gives consent to receive protective services, the department shall assist the adult in locating and arranging for necessary services in the least restrictive environment reasonably available.
[660.270.] 192.2115. When the department receives a report that there has been abuse or neglect, or that there otherwise is a likelihood of serious physical harm to an eligible adult and that he or she is in need of protective services and the department is unable to conduct an investigation because access to the eligible adult is barred by any person, the director may petition the appropriate court for a warrant or other order to enter upon the described premises and investigate the report or to produce the information. The application for the warrant or order shall identify the eligible adult and the facts and circumstances which require the issuance of the warrant or order. The director may also seek an order to enjoin the person from barring access to an eligible adult or from interfering with the investigation. If the court finds that, based on the report and relevant circumstances and facts, probable cause exists showing that the eligible adult faces abuse or neglect, or otherwise faces a likelihood of serious physical harm and is in need of protective services and the director has been prevented by another person from investigating the report, the court may issue the warrant or enjoin the interference with the investigation or both.
[660.275.] 192.2118. If an eligible adult gives consent to receive protective services and any other person interferes with or prevents the delivery of such services, the director may petition the appropriate court for an order to enjoin the interference with the delivery of the services. The petition shall allege the consent of the eligible adult and shall allege specific facts sufficient to show that the eligible adult faces a likelihood of serious physical harm and is in need of the protective services and that delivery is barred by the person named in the petition. If the court finds upon a preponderance of evidence that the allegations in the petition are true, the court may issue an order enjoining the interference with the delivery of the protective services and may establish such conditions and restrictions on the delivery as the court deems necessary and proper under the circumstances.
[660.280.] 192.2121. When an eligible adult facing the likelihood of serious physical harm and in need of protective services is unable to give consent because of incapacity or legal disability and the guardian of the eligible adult refuses to provide the necessary services or allow the provision of such services, the director shall inform the court having supervisory jurisdiction over the guardian of the facts showing that the eligible adult faces the likelihood of serious physical harm and is in need of protective services and that the guardian refuses to provide the necessary services or allow the provision of such services under the provisions of sections [660.250 to 660.295] 192.2100 to 192.2130. Upon receipt of such information, the court may take such action as it deems necessary and proper to insure that the eligible adult is able to meet his essential human needs.
[660.285.] 192.2124. 1. If the director determines after an investigation that an eligible adult is unable to give consent to receive protective services and presents a likelihood of serious physical harm, the director may initiate proceedings pursuant to chapter 202, RSMo, or chapter 475, RSMo, if appropriate.
2. In order to expedite adult guardianship and conservatorship cases, the department may retain, within existing funding sources of the department, legal counsel on a case-by-case basis.
[660.290.] 192.2127. 1. When a peace officer has probable cause to believe that an eligible adult will suffer an imminent likelihood of serious physical harm if not immediately placed in a medical facility for care and treatment, that the adult is incapable of giving consent, and that it is not possible to follow the procedures in section [660.285] 192.2124, the officer may transport, or arrange transportation for, the eligible adult to an appropriate medical facility which may admit the eligible adult and shall notify the next of kin, if known, and the director.
2. Where access to the eligible adult is barred and a substantial likelihood exists of serious physical harm resulting to the eligible adult if he is not immediately afforded protective services, the peace officer may apply to the appropriate court for a warrant to enter upon the described premises and remove the eligible adult. The application for the warrant shall identify the eligible adult and the circumstances and facts which require the issuance of the warrant.
3. If immediately upon admission to a medical facility, a person who is legally authorized to give consent for the provision of medical treatment for the eligible adult, has not given or refused to give such consent, and it is the opinion of the medical staff of the facility that treatment is necessary to prevent serious physical harm, the director or the head of the medical facility shall file a petition in the appropriate court for an order authorizing specific medical treatment. The court shall hold a hearing and issue its decision forthwith. Notwithstanding the above, if a licensed physician designated by the facility for such purpose examines the eligible adult and determines that the treatment is immediately or imminently necessary and any delay occasioned by the hearing provided in this subsection would jeopardize the life of the person affected, the medical facility may treat the eligible adult prior to such court hearing.
4. The court shall conduct a hearing pursuant to chapter 475, RSMo, forthwith and, if the court finds the eligible adult incapacitated, it shall appoint a guardian ad litem for the person of the eligible adult to determine the nature and extent of the medical treatment necessary for the benefit of the eligible adult and to supervise the rendition of such treatment. The guardian ad litem shall promptly report the completion of treatment to the court, who shall thereupon conduct a restoration hearing or a hearing to appoint a permanent guardian.
5. The medical care under this section may not be rendered in a mental health facility unless authorized pursuant to the civil commitment procedures in chapter 632, RSMo.
6. Nothing contained in this section or [in any other section of sections 660.250 to 660.295] sections 192.2100 to 192.2130 shall be construed as requiring physician or medical care or hospitalization of any person who, because of religious faith or conviction, relies on spiritual means or prayer to cure or prevent disease or suffering nor shall any provision of sections [660.250 to 660.295] 192.2100 to 192.2130 be construed so as to designate any person as an eligible adult who presents a likelihood of suffering serious physical harm and is in need of protective services solely because such person, because of religious faith or conviction, relies on spiritual means or prayer to cure or prevent disease or suffering.
[660.295.] 192.2130. If an eligible adult does not consent to the receipt of reasonable and necessary protective services, or if an eligible adult withdraws previously given consent, the protective services shall not be provided or continued; except that, if the director has reasonable cause to believe that the eligible adult lacks the capacity to consent, the director may seek a court order pursuant to the provisions of section [660.285] 192.2124.
[198.070.] 192.2150. 1. [When] As used in sections 192.2150 to 192.2187, unless the context clearly indicates otherwise, the following terms mean:
(1) "Consumer", a consumer of personal care assistance services as defined in section 208.900, RSMo;
(2) "In-home services client", the same meaning as such term is defined in section 192.2100 or a participant in a healthy children and youth program who receives in-home care authorized by the department in accordance with the provisions of Section 6403 of P.L. 101-239 and federal regulations promulgated thereunder;
(3) "Misappropriation", the dishonest conversion of property or moneys of a patient, resident, in-home services client, or consumer;
(4) "Patient", any patient of any entity licensed or certified under chapter 197, RSMo, or a client of any adult day care provider, as defined in section 192.2200;
(5) "Personal care attendant", a person hired to provide personal care assistance services as defined in section 208.900, RSMo;
(6) "Principal", a provider officer, director, owner, partner, or other person with primary management or supervisory responsibilities;
(7) "Provider", any person or entity who:
(a) Is licensed or certified as an operator under chapter 197 or 198, RSMo;
(b) Provides in-home services under contract with the department;
(c) Employees health care staff for temporary or intermittent placement in health care facilities;
(d) Is a licensed adult day care provider;
(e) Is a vendor as defined in section 208.900, RSMo; or
(f) Has a MO HealthNet participation agreement and employs persons to deliver any kind of services provided for patients, in-home services clients, or consumers in their private homes;
(8) "Resident", any resident of any entity licensed or certified under chapter 198, RSMo.
2. Any adult day care worker; chiropractor; Christian Science practitioner; coroner; dentist; embalmer; employee of the departments of social services, mental health, or health and senior services; employee of a local area agency on aging or an organized area agency on aging program; funeral director; home health agency or home health agency employee; hospital and clinic personnel engaged in examination, care, or treatment of persons; in-home services owner, provider, operator, or employee; law enforcement officer; long-term care facility administrator or employee; medical examiner; medical resident or intern; mental health professional; minister; nurse; nurse practitioner; optometrist; other health practitioner; peace officer; pharmacist; physical therapist; physician; physician's assistant; podiatrist; probation or parole officer; psychologist; social worker; personal care attendant as defined in section 208.900, RSMo; owner, operator, or employee of a vendor as defined in section 208.900, RSMo; or other person charged with the care of a person sixty years of age or older or an eligible adult, as defined in section 192.2100, who has reasonable cause to believe that a [resident of a facility] patient, resident, in-home services client, or consumer has been abused or neglected, [he or she] that misappropriation of property or moneys belonging to a patient, resident, in-home services client, or consumer has occurred, or that the falsification of any documents verifying service delivery of in-home services or consumer-directed services has occurred shall [immediately] report or cause a report to be made to the department within twenty-four hours after the later of the act or discovery of the act by such person.
[2.] 3. In addition to those persons required to report under subsection 2 of this section, any other person having reasonable cause to believe that a patient, resident, in-home services client, or consumer has been abused or neglected, that misappropriation of property or moneys belonging to a patient, resident, in-home services client, or consumer has occurred, or that falsification of any documents verifying service delivery of in-home services or consumer-directed services has occurred may report such information to the department.
4. If a report is made by the patient's, in-home services client's, or resident's physician, the department shall provide information regarding the progress of the investigation to the physician upon request.
5. The report shall contain:
(1) The name and address of the [facility, the name of the resident,] provider and the patient, resident, in-home services client, or consumer;
(2) Information regarding the nature of the abuse or neglect, misappropriation, or falsification of documents verifying service delivery;
(3) The name of the complainant[,] ; and
(4) Any other information which might be helpful in an investigation.
[3. Any person required in subsection 1 of this section to report or cause a report to be made to the department who knowingly fails to make a report within a reasonable time after the act of abuse or neglect as required in this subsection is guilty of a class A misdemeanor.
4. In addition to the penalties imposed by this section, any administrator who knowingly conceals any act of abuse or neglect resulting in death or serious physical injury, as defined in section 565.002, RSMo, is guilty of a class D felony.
5. In addition to those persons required to report pursuant to subsection 1 of this section, any other person having reasonable cause to believe that a resident has been abused or neglected may report such information to the department.]
6. Upon receipt of a report that indicates an imminent danger to the health, safety, or welfare of a patient, resident, in-home services client, or consumer, or substantial probability that death or serious physical injury will result, the department shall [initiate an investigation within twenty-four hours and] make a prompt and thorough investigation. The department shall initiate all other investigations as soon as practicable. As provided in section 565.186, RSMo, substantiated reports of elder abuse shall be promptly reported by the department to the appropriate law enforcement agency and prosecutor. In the case of investigations alleging abuse, neglect, misappropriation, or exploitation of a resident of a facility licensed under chapter 198, RSMo, by a facility employee or other resident:
(1) If the resident has been appointed a guardian or conservator, or both, under chapter 475, RSMo, or if the resident has been certified to be incapacitated in accordance with sections 404.800 to 404.872, RSMo, the department, as soon as possible during the course of the investigation, shall notify the resident's [next of kin or responsible party] legal representative of the report [and] , the investigation, and [further notify them] whether the report was substantiated or unsubstantiated unless such person is the alleged perpetrator [of the abuse or neglect.] ;
(2) The department may notify family members or guardians of the results of investigations in accordance with section 198.532, RSMo.
[As provided in section 565.186, RSMo, substantiated reports of elder abuse shall be promptly reported by the department to the appropriate law enforcement agency and prosecutor.]
7. If the investigation indicates possible abuse or neglect