A BILL TO BE ENTITLED
AN ACT to authorize the medical care commission to adopt rules allowing the issuance of Rated certificates to adult care homes, To Direct the Department of Health and Human services to Study Related issues, and to appropriate funds to the Department of Health and Human Services, Division of Facility Services, for additional positions and database enhancement to support the program.
The General Assembly of North Carolina enacts:
SECTION 1.(a)  G.S. 131D‑4.5 reads as rewritten:
"§ 131D‑4.5.  Rules adopted by Medical Care Commission.
The Medical Care Commission shall adopt rules as follows:
(1)	Establishing minimum medication administration standards for adult care homes. The rules shall include the minimum staffing and training requirements for medication aides and standards for professional supervision of adult care homes' medication controls. The requirements shall be designed to reduce the medication error rate in adult care homes to an acceptable level. The requirements shall include, but need not be limited to, all of the following:
a.	Training for medication aides, including periodic refresher training.
b.	Standards for management of complex medication regimens.
c.	Oversight by licensed professionals.
d.	Measures to ensure proper storage of medication.
(2)	Establishing training requirements for adult care home staff in behavioral interventions. The training shall include appropriate responses to behavioral problems posed by adult care residents. The training shall emphasize safety and humane care and shall specifically include alternatives to the use of restraints.
(3)	Establishing minimum training and education qualifications for supervisors in adult care homes and specifying the safety responsibilities of supervisors.
(4)	Specifying the qualifications of staff who shall be on duty in adult care homes during various portions of the day in order to assure safe and quality care for the residents. The rules shall take into account varied resident needs and population mixes.
(5)	Implementing the due process and appeal rights for discharge and transfer of residents in adult care homes afforded by G.S. 131D‑21. The rules shall offer at least the same protections to residents as State and federal rules and regulations governing the transfer or discharge of residents from nursing homes.
(6)	Establishing procedures for determining the compliance history of adult care homes' principals and affiliates. The rules shall include criteria for refusing to license facilities which have a history of, or have principals or affiliates with a history of, noncompliance with State law, or disregard for the health, safety, and welfare of residents.
(7)	For the licensure of special care units in accordance with G.S. 131D‑4.6, and for disclosures required to be made under G.S. 131D‑8.
(8)	For time limited provisional licenses and for granting extensions for provisional licenses.
(9)	For the issuance of certificates to adult care homes which shall contain a rating based, at a minimum, on the following:
a.	Inspections and substantiated complaint investigations conducted by the Department to determine compliance with licensing statutes and rules. Specific areas to be reviewed include:
1.	Admission and discharge procedures.
2.	Medication management.
3.	Physical plant.
4.	Resident care and services, including food services, resident activities programs, and safety measures.
5.	Residents' rights.
6.	Sanitation grade.
7.	Special Care Units.
8.	Use of physical restraints and alternatives."
SECTION 1.(b)  The initial ratings awarded to a facility pursuant to the rules adopted under this section shall be based on inspections, penalties imposed, and investigations of substantiated complaints that revealed noncompliance with statutes and rules, that occurred on or after the act becomes law.
SECTION 1.(c)  Type A penalties shall affect the rating for 24 months from the date the penalty is assessed.  Type B penalties shall affect the rating for 12 months from the date the penalty is assessed.
SECTION 1.(d)  In the event of a change in ownership of an adult care home, the home shall be reevaluated within six months of the change in ownership to determine its rating.  
SECTION 1.(e)  Adult care homes shall post the rating certificate in a location visible to the public.  Certificates shall include the Web site address for the Department of Health and Human Services, Division of Facility Services, which can be accessed for specific information regarding the basis of the facility rating.  For access by the public on request, adult care homes shall also maintain on‑site a copy of information provided by the Department of Health and Human Services, Division of Facility Services, regarding the basis of the facility rating.  In addition to information on the basis of the rating, the Department of Health and Human Services, Division of Facility Services, shall make information available via its Web site and in the materials available on‑site at the facility regarding quality improvement efforts undertaken by the facility including:
(1)	Participation in any quality improvement programs approved by the Department.
(2)	The facility's attainment of the North Carolina New Organizational Vision Award special licensure designation authorized in Article 5, Chapter 131E of the General Statutes. 
SECTION 1.(f)  The proposed rules adopted pursuant to this section shall not go into effect until the Department of Health and Human Services has reported on the proposed rules to the North Carolina Study Commission on Aging.  The Department of Health and Human Services shall report on the proposed rules to the North Carolina Study Commission on Aging not later than January 1, 2008. 
SECTION 2.(a)  The Department of Health and Human Services, Division of Facility Services, shall study the following: 
(1)	The structure and cost of a system to reward adult care homes which receive high ratings.
(2)	The development of a quality improvement program to provide technical assistance targeted to facilities that receive low ratings.
The Department shall report findings and recommendations on this study to the North Carolina Study Commission on Aging not later than March 1, 2008.
SECTION 2.(b)  The Department of Health and Human Services, Division of Facility Services and Division of Aging and Adult Services shall study expanding the rated certificate system to other facilities and services licensed and certified by the Department. The Department shall report to the North Carolina Study Commission on Aging on the expansion of the rating system by October 1, 2009.
SECTION 2.(c)  The Department of Health and Human Services, Division of Facility Services, shall report on the implementation of the rated certificate system.  The Department shall make an interim report to the North Carolina Study Commission on Aging not later than October 1, 2009, and a final report to the Commission not later than October 1, 2010.       
SECTION 3.  There is appropriated from the General Fund to the Department of Health and Human Services, Division of Facility Services, the sum of one hundred fifty‑three thousand dollars ($153,000) for the 2007‑2008 fiscal year and the sum of one hundred eight thousand dollars ($108,000) for the 2008‑2009 fiscal year.  These funds shall be used to implement the Star Rating Program in accordance with Section 1 of this act, including two new positions and enhancement and maintenance of a database for the Program.
SECTION 4.  Section 1 of this act is effective when it becomes law and requires the issuance of certificates beginning January 1, 2009.  Section 3 of this act becomes effective July 1, 2007. The remainder of this act is effective when it becomes law.