A BILL TO BE ENTITLED
AN ACT TO MAKE CHANGES TO THE HOME CARE AGENCY LICENSURE ACT, TO ESTABLISH HOME CARE CLIENTS' RIGHTS, and to appropriate funds to increase the survey cycle for licensed in‑home agencies, AS RECOMMENDED BY THE NORTH CAROLINA STUDY COMMISSION ON AGING.
The General Assembly of North Carolina enacts:
SECTION 1.  G.S. 131E‑140 reads as rewritten:
"§ 131E‑140.  Rules and enforcement.
(a)	The Commission  may adopt, amend and repeal all rules necessary for the implementation of this  Part and Part 3A of Article 6 of this Chapter. Provided, these rules shall not extend, modify, or limit the licensing of individual health professionals by their respective licensing boards; nor shall these rules in any way be construed to extend the appropriate scope of practice of any individual health care provider.
(a1)	The Commission shall adopt rules that recognize the different types of home care services and shall adopt specific requirements for the provision of each type of home care service.
(a2)	The Commission shall adopt rules defining geographic service areas and staffing qualifications for licensed home care agencies.
(a3)	The Commission shall adopt rules prohibiting licensed home care agencies from hiring individuals listed on the Health Care Personnel Registry in accordance with G.S. 131E‑256(a)(1).
(a4)	The Commission shall adopt rules requiring applicants for home care licensure to receive training in the requirements for licensure, the licensure process, and the rules pertaining to the operation of a home care agency.
(b)	The Department shall enforce the rules adopted or amended by the Commission with respect to home care agencies."
SECTION 2.  G.S. 131E‑136 reads as rewritten:
"§ 131E‑136.  Definitions.
As used in this Part, unless otherwise specified:
(1)	"Commission" means the North Carolina Medical Care Commission.
(1a)	"Geographic service area" means the geographic area in which a licensed agency provides home care services.
(2)	"Home care agency" means a private or public organization that provides home care services.
(2a)	"Home care agency director" means the person having administrative responsibility for the operation of the agency.
(2b)	"Home care client" means an individual who receives home care services.
(3)	"Home care services" means any of the following services and directly related medical supplies and appliances, which are  provided to an individual in a place of temporary or permanent residence used as an individual's home:
a.	Nursing care provided by or under the supervision of a registered nurse;
b.	Physical, occupational, or speech therapy, when provided to an individual who also is receiving nursing services, or any other of these therapy services, in a place of temporary or permanent residence used as the individual's home;
c.	Medical social services;
d.	In‑home aide services that involve hands‑on care to an individual;
e.	Infusion nursing services; and
f.	Assistance with pulmonary care, pulmonary rehabilitation or ventilation.
The term does not include: health promotion, preventative health and community health services provided by public health departments; maternal and child health services provided by public health departments, by employees of the Department of Health and Human Services under G.S. 130A‑124, or by developmental evaluation centers under contract with the Department of Health and Human Services to provide services under G.S. 130A‑124; hospitals licensed under Article 5 of Chapter 131E of the General Statutes when providing follow‑up care initiated to patients within six months after their discharge from the hospital; facilities and programs operated under the authority of G.S. 122C and providing services within the scope of G.S. 122C; schools, when providing services pursuant to Article 9 of Chapter 115C; the practice of midwifery by a person licensed under Article 10A of Chapter 90 of the General Statutes; hospices licensed under Article 10 of Chapter 131E of the General Statutes when providing care to a hospice patient; an individual who engages solely in providing his own services to other individuals; incidental health care provided by an employee of a physician licensed to practice medicine in North Carolina in the normal course of the physician's practice; or nursing registries if the registry discloses to a client or the client's responsible party, before providing any services, that (i) it is not a licensed home care agency, and (ii) it does not make any representations or guarantees concerning the training, supervision, or competence of the personnel provided.
(4)	"Home health agency" means a home care agency which is certified to receive Medicare and Medicaid reimbursement for providing nursing care, therapy, medical social services, and home health aide services on a part‑time, intermittent basis as set out in G.S. 131E‑176(12), and is thereby also subject to Article 9 of Chapter 131E."
SECTION 3.  Article 6 of Chapter 131E of the General Statutes is amended by adding a new Part to read:
"Part 3A. Home Care Clients' Bill of Rights.
"§ 131E‑144.1.  Legislative intent.
It is the intent of the General Assembly to support an individual's desire to live at home and receive home care services.
"§ 131E‑144.2.  Definitions.
Unless otherwise specified, the definitions that are provided in Part 3 of Article 6 of this Chapter apply in this Part.
"§ 131E‑144.3.  Declaration of home care clients' rights.
Each client of a home care agency shall have the following rights:
(1)	To be informed and participate in his or her plan of care.
(2)	To be treated with respect, consideration, dignity, and full recognition of his or her individuality and right to privacy.
(3)	To receive care and services that are adequate, appropriate, and in compliance with relevant federal and State laws and rules and regulations.
(4)	To voice grievances about care and not be subjected to discrimination or reprisal for doing so.
(5)	To have his or her personal and medical records kept confidential and not be disclosed without appropriate written consent.
(6)	To be free of mental and physical abuse, neglect, and exploitation.
(7)	To receive a written statement of services provided by the agency and the charges for these services.
(8)	To be informed of the process for acceptance and continuance of service and eligibility determination.
(9)	To accept or refuse services.
(10)	To be informed of the agency's on‑call service.
(11)	To be informed of supervisory accessibility and availability.
(12)	To be advised of the agency's procedures for discharge.
(13)	To receive a reasonable response to his or her requests of the agency.
(14)	To be notified within 10 days when the agency's license has been revoked, suspended, canceled, annulled, withdrawn, recalled, or amended.
"§ 131E‑144.4.  Notice to client.
(a)	During the agency's initial evaluation visit or before furnishing services, a home care agency shall provide each client with the following:
(1)	A copy of the declaration of home care clients' rights.
(2)	The address and telephone number for information, questions, or complaints about services provided by the agency.
(3)	The address and telephone number of the section of the Department of Health and Human Services responsible for the enforcement of the provisions of this Part.
(4)	The address and telephone number of the county social services department.
(b)	Receipts for the declaration of home care clients' rights and contact information required in this section shall be signed by the client and shall be retained in the agency's files.
"§ 131E‑144.5. Implementation.
Responsibility for implementing the provisions of this Part shall rest with the agency director. Each agency shall provide appropriate training to implement this Part.
"§ 131E‑144.6.  Enforcement and investigation.
(a)	The Department of Health and Human Services shall be responsible for the provisions of this Part. The Department shall investigate complaints made to it and reply within a reasonable period of time, not to exceed 60 days.
(a1)	When the Department of Health and Human Services receives a complaint alleging a violation of the provisions of this Part pertaining to client care or client safety, the Department shall initiate an investigation as follows:
(1)	Immediately upon receipt of the complaint if the complaint alleges a life‑threatening situation.
(2)	Within 24 hours if the complaint alleges abuse of a client as defined by G.S. 131D‑20(1).
(3)	Within 48 hours if the complaint alleges neglect of a client as defined by G.S. 131D‑20(8).
(4)	Within two weeks in all other situations.
The investigation shall be completed within 30 days. The requirements of this section are in addition to and not in lieu of any investigatory and reporting requirements for health care personnel pursuant to Article 15 of this Chapter, or for adult protective services pursuant to Article 6 of Chapter 108A of the General Statutes.
(b)	A home care agency shall investigate, within 72 hours, complaints made to the agency by a home care client or the client's family and must document both the existence of the complaint and the resolution of the complaint.
"§ 131E‑144.7.  Confidentiality.
(a)	The Department of Health and Human Services is authorized to inspect home care clients' medical records maintained at the agency when necessary to investigate any alleged violation of this Part.
(b)	The Department shall maintain the confidentiality of all persons who register complaints with the Department and of all medical records inspected by the Department. A person who has filed a complaint shall have access to information about a complaint investigation involving a specific home care client if written authorization is obtained from the client or legal representative."
SECTION 4.  There is appropriated from the General Fund to the Department of Health and Human Services, Division of Facility Services, the sum of five hundred fifty thousand dollars ($550,000) for the 2005‑2006 fiscal year and the sum of five hundred fifty thousand dollars ($550,000) for the 2006‑2007 fiscal year to increase the survey cycle to every two years for licensed only home care agencies.
SECTION 5.  The Department of Health and Human Services shall study whether there are any additional "health care facilities" and "health care personnel" that are employed in health care settings that should be contained in the Health Care Personnel Registry and listed in G.S. 131E‑256.  The Department shall report its findings and recommendations to the North Carolina Study Commission on Aging by December 1, 2005.
SECTION 6.  Section 4 of this act becomes effective July 1, 2005. Section 3 of this act becomes effective January 1, 2006. The remainder of this act is effective when it becomes law.