March 14, 2006, Introduced by Senators JACOBS, PRUSI, GEORGE, CLARKE, KUIPERS and SCHAUER and referred to the Committee on Economic Development, Small Business and Regulatory Reform.
A bill to amend 1978 PA 368, entitled
"Public health code,"
by amending sections 20155, 20156, and 22210 (MCL 333.20155,
333.20156, and 333.22210), section 20155 as amended by 2001 PA 218,
section 20156 as amended by 1990 PA 179, and section 22210 as
amended by 1993 PA 88; and to repeal acts and parts of acts.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec. 20155. (1) Except as otherwise provided in this section,
the
department of consumer and industry services shall
make
annual and other visits to each health facility or agency licensed
under this article for the purposes of survey, evaluation, and
consultation. A visit made pursuant to a complaint shall be
unannounced. Except for a county medical care facility, a home for
the aged, a nursing home, or a hospice residence, the department
shall determine whether the visits that are not made pursuant to a
complaint are announced or unannounced. Beginning June 20, 2001,
the department shall assure that each newly hired nursing home
surveyor, as part of his or her basic training, is assigned full-
time to a licensed nursing home for at least 10 days within a 14-
day period to observe actual operations outside of the survey
process before the trainee begins oversight responsibilities. A
member of a survey team shall not be employed by a licensed nursing
home or a nursing home management company doing business in this
state at the time of conducting a survey under this section. The
department shall not assign an individual to be a member of a
survey team for purposes of a survey, evaluation, or consultation
visit at a nursing home in which he or she was an employee within
the preceding 5 years.
(2)
The department of consumer and industry services shall
make at least a biennial visit to each licensed clinical
laboratory, each nursing home, and each hospice residence for the
purposes
of survey, evaluation, and consultation. The department
of
consumer and industry services shall semiannually provide for
joint training with nursing home surveyors and providers on at
least 1 of the 10 most frequently issued federal citations in this
state
during the past calendar year. The department of consumer
and
industry services shall develop a protocol for the review of
citation patterns compared to regional outcomes and standards and
complaints regarding the nursing home survey process. The review
will result in a report provided to the legislature. Except as
otherwise provided in this subsection, beginning with his or her
first full relicensure period after June 20, 2000, each member of a
department of
consumer and industry services nursing home survey
team who is a health professional licensee under article 15 shall
earn not less than 50% of his or her required continuing education
credits, if any, in geriatric care. If a member of a nursing home
survey team is a pharmacist licensed under article 15, he or she
shall earn not less than 30% of his or her required continuing
education credits in geriatric care.
(3)
The department of consumer and industry services shall
make a biennial visit to each hospital for survey and evaluation
for the purpose of licensure. Subject to subsection (6), the
department may waive the biennial visit required by this subsection
if a hospital, as part of a timely application for license renewal,
requests a waiver and submits both of the following and if all of
the requirements of subsection (5) are met:
(a) Evidence that it is currently fully accredited by a body
with expertise in hospital accreditation whose hospital
accreditations are accepted by the United States department of
health and human services for purposes of section 1865 of part C of
title
XVIII of the social security act, 42
U.S.C. USC 1395bb.
(b) A copy of the most recent accreditation report for the
hospital issued by a body described in subdivision (a), and the
hospital's responses to the accreditation report.
(4) Except as provided in subsection (8), accreditation
information
provided to the department of consumer and industry
services
under subsection (3) is confidential, is not a
public
record, and is not subject to court subpoena. The department shall
use the accreditation information only as provided in this section
and shall return the accreditation information to the hospital
within a reasonable time after a decision on the waiver request is
made.
(5)
The department of consumer and industry services shall
grant a waiver under subsection (3) if the accreditation report
submitted under subsection (3)(b) is less than 2 years old and
there is no indication of substantial noncompliance with licensure
standards or of deficiencies that represent a threat to public
safety or patient care in the report, in complaints involving the
hospital, or in any other information available to the department.
If the accreditation report is 2 or more years old, the department
may do 1 of the following:
(a) Grant an extension of the hospital's current license until
the next accreditation survey is completed by the body described in
subsection (3)(a).
(b) Grant a waiver under subsection (3) based on the
accreditation report that is 2 or more years old, on condition that
the hospital promptly submit the next accreditation report to the
department.
(c) Deny the waiver request and conduct the visits required
under subsection (3).
(6) This section does not prohibit the department from citing
a violation of this part during a survey, conducting investigations
or inspections pursuant to section 20156, or conducting surveys of
health facilities or agencies for the purpose of complaint
investigations or federal certification. This section does not
prohibit
the state fire marshal bureau of fire services created
in section 1b of the fire prevention code, 1941 PA 207, MCL 29.1b,
from conducting annual surveys of hospitals, nursing homes, and
county medical care facilities.
(7) At the request of a health facility or agency, the
department of
consumer and industry services may conduct a
consultation engineering survey of a health facility and provide
professional advice and consultation regarding health facility
construction and design. A health facility or agency may request a
voluntary consultation survey under this subsection at any time
between licensure surveys. The fees for a consultation engineering
survey are the same as the fees established for waivers under
section 20161(10).
(8)
If the department of consumer and industry services
determines that substantial noncompliance with licensure standards
exists or that deficiencies that represent a threat to public
safety or patient care exist based on a review of an accreditation
report submitted pursuant to subsection (3)(b), the department
shall prepare a written summary of the substantial noncompliance or
deficiencies and the hospital's response to the department's
determination. The department's written summary and the hospital's
response are public documents.
(9)
The department of consumer and industry services or a
local health department shall conduct investigations or
inspections, other than inspections of financial records, of a
county medical care facility, home for the aged, nursing home, or
hospice residence without prior notice to the health facility or
agency. An employee of a state agency charged with investigating or
inspecting the health facility or agency or an employee of a local
health department who directly or indirectly gives prior notice
regarding an investigation or an inspection, other than an
inspection of the financial records, to the health facility or
agency or to an employee of the health facility or agency, is
guilty of a misdemeanor. Consultation visits that are not for the
purpose of annual or follow-up inspection or survey may be
announced.
(10)
The department of consumer and industry services shall
maintain a record indicating whether a visit and inspection is
announced or unannounced. Information gathered at each visit and
inspection, whether announced or unannounced, shall be taken into
account in licensure decisions.
(11)
The department of consumer and industry services shall
require periodic reports and a health facility or agency shall give
the department access to books, records, and other documents
maintained by a health facility or agency to the extent necessary
to carry out the purpose of this article and the rules promulgated
under this article. The department shall respect the
confidentiality of a patient's clinical record and shall not
divulge or disclose the contents of the records in a manner that
identifies an individual except under court order. The department
may copy health facility or agency records as required to document
findings.
(12)
The department of consumer and industry services may
delegate survey, evaluation, or consultation functions to another
state agency or to a local health department qualified to perform
those functions. However, the department shall not delegate survey,
evaluation, or consultation functions to a local health department
that owns or operates a hospice or hospice residence licensed under
this article. The delegation shall be by cost reimbursement
contract between the department and the state agency or local
health department. Survey, evaluation, or consultation functions
shall not be delegated to nongovernmental agencies, except as
provided in this section. The department may accept voluntary
inspections performed by an accrediting body with expertise in
clinical laboratory accreditation under part 205 if the accrediting
body utilizes forms acceptable to the department, applies the same
licensing standards as applied to other clinical laboratories, and
provides the same information and data usually filed by the
department's own employees when engaged in similar inspections or
surveys. The voluntary inspection described in this subsection
shall be agreed upon by both the licensee and the department.
(13)
If, upon investigation, the department
of consumer and
industry
services or a state agency determines that an individual
licensed to practice a profession in this state has violated the
applicable licensure statute or the rules promulgated under that
statute, the department, state agency, or local health department
shall forward the evidence it has to the appropriate licensing
agency.
(14)
The department of consumer and industry services shall
report to the appropriations subcommittees, the senate and house of
representatives standing committees having jurisdiction over issues
involving senior citizens, and the fiscal agencies on March 1 of
each year on the initial and follow-up surveys conducted on all
nursing homes in this state. The report shall include all of the
following information:
(a) The number of surveys conducted.
(b) The number requiring follow-up surveys.
(c) The number referred to the Michigan public health
institute for remediation.
(d) The number of citations per nursing home.
(e) The number of night and weekend complaints filed.
(f) The number of night and weekend responses to complaints
conducted by the department.
(g) The average length of time for the department to respond
to a complaint filed against a nursing home.
(h) The number and percentage of citations appealed.
(i) The number and percentage of citations overturned or
modified, or both.
(15)
The department of consumer and industry services shall
report annually to the standing committees on appropriations and
the standing committees having jurisdiction over issues involving
senior citizens in the senate and the house of representatives on
the percentage of nursing home citations that are appealed and the
percentage of nursing home citations that are appealed and amended
through the informal deficiency dispute resolution process.
(16) Subject to subsection (17), a clarification work group
comprised
of the department of consumer and industry services in
consultation with a nursing home resident or a member of a nursing
home resident's family, nursing home provider groups, the American
medical
directors association, the department of community health,
the state long-term care ombudsman, and the federal centers for
medicare and medicaid services shall clarify the following terms as
those terms are used in title XVIII and title XIX and applied by
the department to provide more consistent regulation of nursing
homes in Michigan:
(a) Immediate jeopardy.
(b) Harm.
(c) Potential harm.
(d) Avoidable.
(e) Unavoidable.
(17) All of the following clarifications developed under
subsection (16) apply for purposes of subsection (16):
(a)
Specifically, the term "immediate jeopardy" means "
a
situation in which immediate corrective action is necessary because
the nursing home's noncompliance with 1 or more requirements of
participation has caused or is likely to cause serious injury,
harm, impairment, or death to a resident receiving care in a
nursing
home. ".
(b) The likelihood of immediate jeopardy is reasonably higher
if there is evidence of a flagrant failure by the nursing home to
comply with a clinical process guideline adopted under subsection
(18) than if the nursing home has substantially and continuously
complied with those guidelines. If federal regulations and
guidelines are not clear, and if the clinical process guidelines
have been recognized, a process failure giving rise to an immediate
jeopardy may involve an egregious widespread or repeated process
failure and the absence of reasonable efforts to detect and prevent
the process failure.
(c) In determining whether or not there is immediate jeopardy,
the survey agency should consider at least all of the following:
(i) Whether the nursing home could reasonably have been
expected to know about the deficient practice and to stop it, but
did not stop the deficient practice.
(ii) Whether the nursing home could reasonably have been
expected to identify the deficient practice and to correct it, but
did not correct the deficient practice.
(iii) Whether the nursing home could reasonably have been
expected to anticipate that serious injury, serious harm,
impairment, or death might result from continuing the deficient
practice, but did not so anticipate.
(iv) Whether the nursing home could reasonably have been
expected to know that a widely accepted high-risk practice is or
could be problematic, but did not know.
(v) Whether the nursing home could reasonably have been
expected to detect the process problem in a more timely fashion,
but did not so detect.
(d) The existence of 1 or more of the factors described in
subdivision (c), and especially the existence of 3 or more of those
factors simultaneously, may lead to a conclusion that the situation
is one in which the nursing home's practice makes adverse events
likely to occur if immediate intervention is not undertaken, and
therefore constitutes immediate jeopardy. If none of the factors
described in subdivision (c) is present, the situation may involve
harm or potential harm that is not immediate jeopardy.
(e)
Specifically, "actual harm" means " a
negative outcome
to a resident that has compromised the resident's ability to
maintain or reach, or both, his or her highest practicable
physical, mental, and psychosocial well-being as defined by an
accurate and comprehensive resident assessment, plan of care, and
provision
of services. ". Harm
does not include a deficient
practice that only may cause or has caused limited consequences to
the resident.
(f) For purposes of subdivision (e), in determining whether a
negative outcome is of limited consequence, if the "state
operations manual" or "the guidance to surveyors" published by the
federal centers for medicare and medicaid services does not provide
specific guidance, the department may consider whether most people
in similar circumstances would feel that the damage was of such
short duration or impact as to be inconsequential or trivial. In
such a case, the consequence of a negative outcome may be
considered more limited if it occurs in the context of overall
procedural consistency with an accepted clinical process guideline
adopted pursuant to subsection (18), as compared to a substantial
inconsistency with or variance from the guideline.
(g) For purposes of subdivision (e), if the publications
described in subdivision (f) do not provide specific guidance, the
department may consider the degree of a nursing home's adherence to
a clinical process guideline adopted pursuant to subsection (18) in
considering whether the degree of compromise and future risk to the
resident constitutes actual harm. The risk of significant
compromise to the resident may be considered greater in the context
of substantial deviation from the guidelines than in the case of
overall adherence.
(h)
To improve consistency and to avoid disputes over "
avoidable "
and " unavoidable "
negative outcomes, nursing
homes and survey agencies must have a common understanding of
accepted process guidelines and of the circumstances under which it
can reasonably be said that certain actions or inactions will lead
to avoidable negative outcomes. If the "state operations manual" or
"the guidance to surveyors" published by the federal centers for
medicare and medicaid services is not specific, a nursing home's
overall documentation of adherence to a clinical process guideline
with a process indicator adopted pursuant to subsection (18) is
relevant information in considering whether a negative outcome was
"
avoidable
" or "
unavoidable
" and may be considered in
the application of that term.
(18) Subject to subsection (19), the department, in
consultation with the clarification work group appointed under
subsection (16), shall develop and adopt clinical process
guidelines that shall be used in applying the terms set forth in
subsection (16). The department shall establish and adopt clinical
process guidelines and compliance protocols with outcome measures
for all of the following areas and for other topics where the
department determines that clarification will benefit providers and
consumers of long-term care:
(a) Bed rails.
(b) Adverse drug effects.
(c) Falls.
(d) Pressure sores.
(e) Nutrition and hydration including, but not limited to,
heat-related stress.
(f) Pain management.
(g) Depression and depression pharmacotherapy.
(h) Heart failure.
(i) Urinary incontinence.
(j) Dementia.
(k) Osteoporosis.
(l) Altered mental states.
(m) Physical and chemical restraints.
(19) The department shall create a clinical advisory committee
to review and make recommendations regarding the clinical process
guidelines with outcome measures adopted under subsection (18). The
department shall appoint physicians, registered professional
nurses, and licensed practical nurses to the clinical advisory
committee, along with professionals who have expertise in long-term
care services, some of whom may be employed by long-term care
facilities. The clarification work group created under subsection
(16) shall review the clinical process guidelines and outcome
measures after the clinical advisory committee and shall make the
final recommendations to the department before the clinical process
guidelines are adopted.
(20) The department shall create a process by which the
director of the division of nursing home monitoring or his or her
designee or the director of the division of operations or his or
her designee reviews and authorizes the issuance of a citation for
immediate jeopardy or substandard quality of care before the
statement of deficiencies is made final. The review shall be to
assure that the applicable concepts, clinical process guidelines,
and other tools contained in subsections (17) to (19) are being
used consistently, accurately, and effectively. As used in this
subsection, "immediate jeopardy" and "substandard quality of care"
mean those terms as defined by the federal centers for medicare and
medicaid services.
(21) The department may give grants, awards, or other
recognition to nursing homes to encourage the rapid implementation
of the clinical process guidelines adopted under subsection (18).
(22)
The department shall assess the effectiveness of the
amendatory
act that added this subsection 2001 PA 218. The
department shall file an annual report on the implementation of the
clinical process guidelines and the impact of the guidelines on
resident care with the standing committee in the legislature with
jurisdiction over matters pertaining to nursing homes. The first
report
shall be filed on July 1, of the year following the year in
which
the amendatory act that added this subsection takes effect
2002.
(23)
The department of consumer and industry services shall
instruct and train the surveyors in the use of the clarifications
described in subsection (17) and the clinical process guidelines
adopted under subsection (18) in citing deficiencies.
(24) A nursing home shall post the nursing home's survey
report in a conspicuous place within the nursing home for public
review.
(25) Nothing in this amendatory act shall be construed to
limit the requirements of related state and federal law.
(26) As used in this section:
(a) "Title XVIII" means title XVIII of the social security
act, chapter
531, 49 Stat. 620, 42 U.S.C. 1395 to 1395b, 1395b-2,
1395b-6
to 1395b-7, 1395c to 1395i, 1395i-2 to 1395i-5, 1395j to
1395t,
1395u to 1395w, 1395w-2 to 1395w-4, 1395w-21 to 1395w-28,
1395x
to 1395yy, and 1395bbb to 1395ggg 42
USC 1395 to 1395hhh.
(b) "Title XIX" means title XIX of the social security act,
chapter
531, 49 Stat. 620, 42 U.S.C. 1396 to 1396f, 1396g-1 to
1396r-6,
and 1396r-8 42 USC 1396 to 1396v.
Sec.
20156. (1) A representative of the department of public
health
or the
state fire marshal division of the
department of
state
police, bureau of fire
services created in section 1b of the
fire prevention code, 1941 PA 207, MCL 29.1b, upon presentation of
proper identification, may enter the premises of an applicant or
licensee at any reasonable time to determine whether the applicant
or licensee meets the requirements of this article and the rules
promulgated under this article. The director; the director of
social
the department of human services; the state fire marshal
bureau of fire services; the director of the office of services to
the aging; or the director of a local health department; or an
authorized
representative of the director, the director of social
the
department of human services, the state
fire marshal bureau
of fire services, the director of the office of services to the
aging, or the director of a local health department may enter on
the premises of an applicant or licensee under part 217 at any time
in the course of carrying out program responsibilities.
(2)
The state fire marshal division of the department of
state
police bureau of fire
services created in section 1b of the
fire prevention code, 1941 PA 207, MCL 29.1b, shall enforce rules
promulgated
by the state fire safety board bureau of fire
services for health facilities and agencies to assure that physical
facilities owned, maintained, or operated by a health facility or
agency are planned, constructed, and maintained in a manner to
protect the health, safety, and welfare of patients.
(3)
The department of public health shall not issue a
license or certificate to a health facility or agency until it
receives
an appropriate certificate of approval from the state
fire
marshal division of the department of state police bureau of
fire services. For purposes of this section, a decision of the
state
fire marshal division of the department of state police
bureau of fire services to issue a certificate controls over that
of a local fire department.
(4) Subsections (2) and (3) do not apply to a health facility
or
an agency licensed under part 205
, or
209. , or 210.
Sec. 22210. (1) A hospital that applies to the department for
a certificate of need and meets all of the following criteria shall
be granted a certificate of need for a short-term nursing care
program with up to 10 licensed hospital beds:
(a) Is eligible to apply for certification as a provider of
swing-bed
services under section 1883 of title XVIII, 42 U.S.C.
USC 1395tt.
(b) Subject to subsection (2), has fewer than 100 licensed
beds
not counting beds excluded under section 1883 of title XVIII,
of
the social security act 42
USC 1395tt.
(c) Does not have uncorrected licensing, certification, or
safety
deficiencies for which the department or the state fire
marshal
bureau of fire services
created in section 1b of the fire
prevention code, 1941 PA 207, MCL 29.1b, or both, has not accepted
a plan of correction.
(d) Provides evidence satisfactory to the department that the
hospital has had difficulty in placing patients in skilled nursing
home beds during the 12 months immediately preceding the date of
the application.
(2) After October 1, 1990, the criteria set forth in
subsection (1)(b) may be modified by the commission, using the
procedure set forth in section 22215(3). The department shall not
charge a fee for processing a certificate of need application to
initiate a short-term nursing care program.
(3) A hospital that is granted a certificate of need for a
short-term nursing care program under subsection (1) shall comply
with all of the following:
(a) Not charge for or otherwise attempt to recover the cost of
a length of stay for a patient in the short-term nursing care
program that exceeds the length of time allowed for post-hospital
extended care under title XVIII.
(b) Admit patients to the short-term nursing care program only
pursuant to an admissions contract approved by the department.
(c) Not discharge or transfer a patient from a licensed
hospital bed other than a hospital long-term care unit bed and
admit that patient to the short-term nursing care program unless
the discharge or transfer and admission is determined medically
appropriate by the attending physician.
(d) Permit access to a representative of an organization
approved under section 21764 to patients admitted to the short-term
nursing care program, for all of the purposes described in section
21763.
(e) Subject to subsection (8), not allow the number of patient
days for the short-term nursing care program to exceed the
equivalent of 1,825 patient days for a single state fiscal year.
(f) Transfer a patient in the short-term nursing care program
to an appropriately certified nursing home bed, county medical care
facility bed, or hospital long-term care unit bed located within a
50-mile radius of the patient's residence within 5 business days
after the hospital has been notified, either orally or in writing,
that a bed has become available.
(g) Not charge or collect from a patient admitted to the
short-term nursing care program, for services rendered as part of
the short-term nursing care program, an amount in excess of the
reasonable charge for the services as determined by the United
States secretary of health and human services under title XVIII.
(h) Assist a patient who has been denied coverage for services
received in a short-term nursing care program under title XVIII to
file an appeal with the medicare recovery project operated by the
office of services to the aging.
(i) Operate the short-term nursing care program in accordance
with this section and the requirements of the swing bed provisions
of
section 1883 of title XVIII, 42 U.S.C. USC
1395tt.
(j) Provide data to the department considered necessary by the
department to evaluate the short-term nursing care program. The
data shall include, but is not limited to, all of the following:
(i) The total number of patients admitted to the hospital's
short-term nursing care program during the period specified by the
department.
(ii) The total number of short-term nursing care patient days
for the period specified by the department.
(iii) Information identifying the type of care to which patients
in the short-term care nursing program are released.
(k) As part of the hospital's policy describing the rights and
responsibilities of patients admitted to the hospital, as required
under section 20201, incorporate all of the following additional
rights and responsibilities for patients in the short-term nursing
care program:
(i) A copy of the hospital's policy shall be provided to each
short-term nursing care patient upon admission, and the staff of
the hospital shall be trained and involved in the implementation of
the policy.
(ii) Each short-term nursing care patient may associate and
communicate privately with persons of his or her choice.
Reasonable, regular visiting hours, which shall take into
consideration the special circumstances of each visitor, shall be
established for short-term nursing care patients to receive
visitors. A short-term nursing care patient may be visited by the
patient's attorney or by representatives of the departments named
in section 20156 during other than established visiting hours.
Reasonable privacy shall be afforded for visitation of a short-term
nursing care patient who shares a room with another short-term
nursing care patient. Each short-term nursing care patient shall
have reasonable access to a telephone.
(iii) A short-term nursing care patient is entitled to retain
and use personal clothing and possessions as space permits, unless
medically contraindicated, as documented by the attending physician
in the medical record.
(iv) A short-term nursing care patient is entitled to the
opportunity to participate in the planning of his or her medical
treatment. A short-term nursing care patient shall be fully
informed by the attending physician of the short-term nursing care
patient's medical condition, unless medically contraindicated, as
documented by a physician in the medical record. Each short-term
nursing care patient shall be afforded the opportunity to discharge
himself or herself from the short-term nursing care program.
(v) A short-term nursing care patient is entitled to be fully
informed either before or at the time of admission, and during his
or her stay, of services available in the hospital and of the
related charges for those services. The statement of services
provided by the hospital shall be in writing and shall include
those services required to be offered on an as needed basis.
(vi) A patient in a short-term nursing care program or a person
authorized in writing by the patient may, upon submission to the
hospital of a written request, inspect and copy the patient's
personal or medical records. The hospital shall make the records
available for inspection and copying within a reasonable time, not
exceeding 7 days, after the receipt of the written request.
(vii) A short-term nursing care patient has the right to have
his or her parents, if the short-term nursing care patient is a
minor, or his or her spouse, next of kin, or patient's
representative, if the short-term nursing care patient is an adult,
stay at the facility 24 hours a day if the short-term nursing care
patient is considered terminally ill by the physician responsible
for the short-term nursing care patient's care.
(viii) Each short-term nursing care patient shall be provided
with meals that meet the recommended dietary allowances for that
patient's age and sex and that may be modified according to special
dietary needs or ability to chew.
(ix) Each short-term nursing care patient has the right to
receive a representative of an organization approved under section
21764, for all of the purposes described in section 21763.
(l) Achieve and maintain medicare certification under title
XVIII.
(4) A hospital or the owner, administrator, an employee, or a
representative of the hospital shall not discharge, harass, or
retaliate or discriminate against a short-term nursing care patient
because the short-term nursing care patient has exercised a right
described in subsection (3)(k).
(5) In the case of a short-term nursing care patient, the
rights described in subsection (3)(k)(iv) may be exercised by the
patient's representative, as defined in section 21703(2).
(6) A short-term nursing care patient shall be fully informed,
as evidenced by the short-term nursing care patient's written
acknowledgment, before or at the time of admission and during stay,
of the rights described in subsection (3)(k). The written
acknowledgment shall provide that if a short-term nursing care
patient is adjudicated incompetent and not restored to legal
capacity, the rights and responsibilities set forth in subsection
(3)(k) shall be exercised by a person designated by the short-term
nursing care patient. The hospital shall provide proper forms for
the short-term nursing care patient to provide for the designation
of this person at the time of admission.
(7) Subsection (3)(k) does not prohibit a hospital from
establishing and recognizing additional rights for short-term
nursing care patients.
(8) Upon application, the department may grant a variation
from the maximum number of patient days established under
subsection (3)(e), to an applicant hospital that demonstrates to
the satisfaction of the department that there is an immediate need
for skilled nursing beds within a 100-mile radius of the hospital.
A variation granted under this subsection shall be valid for not
more than 1 year after the date the variation is granted. The
department shall promulgate rules to implement this subsection
including, at a minimum, a definition of immediate need and the
procedure for applying for a variation.
(9) A hospital that violates subsection (3) is subject to the
penalty provisions of section 20165.
(10) A person shall not initiate a short-term nursing care
program without first obtaining a certificate of need under this
section.
Enacting section 1. Section 13310 of the public health code,
1978 PA 368, MCL 333.13310, is repealed.
Enacting section 2. This amendatory act does not take effect
unless Senate Bill No. 1133
of the 93rd Legislature is enacted into law.