HB 1887

This bill generally prohibits a person from operating a prescribed pediatric extended care center ("center"") in this state without an initial or renewal license. Facilities operated by the federal government are exempt from licensure requirements. Each individual center must have its own license. This bill prohibits a person from operating a center in the same location as a child care agency or any other facility licensed by the department of disability and aging or the department of human services. LICENSURE This bill requires a person applying for an initial license to operate a center to submit (i) a sworn application and a form provided by the department of disability and aging (""department""), (ii) a letter of credit to demonstrate the applicant's financi al viability, and (iii) an initial license fee, as established by the department of disability and aging (""department""). The application form must include all of the following:  The location of the center for which the license is sought.  Documentation, signed by the appropriate local government official, stating the location meets local zoning requirements.  The name, address, and social security number of the applicant, the administrator responsible for the daily operations of the center, the financial officer responsible for the financial operations of the center, and any other controlling person. Background and criminal history check information must also be provided for all such persons.  The name, address, and federal employer identification number or taxpayer identification number of the applicant and of each controlling person, if the applicant or controlling person is not an individual.  The business name of the center.  The maximum patient capacity requested for the center.  A sworn affidavit that the applicant has complied, and will continue to comply, with this bill and any rules adopted pursuant to it. This bill requires the department to issue an initial license to a center if the department determines that the applicant and center meet all licensing requirements. The license must include the license holder's name, the location of the center, and a s tatement indicating the center provides services to persons less than 20 (""minors"") for a maximum of 12 hours per day and does not provide 24-hour care. License Renewals This bill requires that licenses to operate a center expire three years after issuance. In order to renew a center license, the applicant must submit a renewal application at least 60 days before the expiration of the license and the license renewal fee. The center must comply with any other renewal requirements established by the department. Late renewal applications are subject to a $50 per day late fee. However, the total late fee must not exceed 50% of the license renewal fee or $500, whichever is less. Display of License This bill requires centers to display their licenses in an obvious location readily visible to persons entering the center. It is a Class B misdemeanor for a person to knowingly establish or operate a center without the appropriate license, with each da y a violation occurs constituting a separate offense. A Class B misdemeanor is punishable by imprisonment of up to six months; a fine of up to $500; or both. Denial, Suspension, and Revocation of Licensure This bill authorizes the department to deny, revoke, or suspend the license of a center, and to impose an administrative fine for a violation of this bill or any applicable rules adopted by the department. The department may take such an action if a cen ter or its employees (i) commit an intentional or negligent act that materially affects the health or safety of a minor in a center, (ii) commit a fraudulent act, or (iii) commit an act that is a violation of this bill or any rules developed by the depart me nt. The department may also take action if there is a license revocation, suspension, or other disciplinary action taken against the license holder or any other person listed in the application in another state. INSPECTIONS This bill requires the department to inspect a center before issuing or renewing a license and authorizes the department to inspect a center at any reasonable time as necessary to ensure compliance with this bill. After an inspection, the department may require a center to take appropriate corrective action to comply with this bill and to submit a corrective action plan to the department for approval. Inspection reports must be made available to any person on request. However, this bill requires the c en ter to redact any information that is confidential. VIOLATIONS If the department determines that a center is not in compliance with this bill or any applicable rules adopted by the department, then this bill authorizes the department to request that the center submit a corrective action plan that demonstrates a good faith effort to remedy each violation by a specific date. This bill authorizes the department to fine a violating center or employee up to $500 for each violation. The failure to correct a violation by the date set by the department, or to comply with a corrective action plan, is generally a separate violation for each such day the failure continues. The department must consider the seriousness of the violation, the threat to health or safety caused by the violation, any previous violations, the amount necessary to deter a future violation, the efforts made to correct the violation, and any other ma tter as necessary to determine if a fine is to be imposed and the amount of any such fine. Injunctions This bill authorizes the department to seek a temporary restraining order from a court in the county in which the center is located seeking immediate closure of a center to prevent further harm or threat of harm to the minors at the center. The departme nt is also authorized to seek any further injunctive relief as permitted by law to protect the minors from violations or threatened violations of licensing laws or rules. CENTER OPERATIONS This bill authorizes a minor to be admitted to the center if such minor meets all of the following criteria:  The minor is a medically dependent or technologically dependent minor.  The minor's prescribing physician issues a prescription ordering care at the center.  The admission is voluntary based on the parent or legal guardian's preferences.  The minor's parent or legal guardian signs a consent document illustrating their involvement in developing and establishing the care and treatment to be provided to the minor in the center. However, this bill clarifies that a minor's parent or legal guardian is not required to accompany the minor when the minor receives services in the center. Further, a center must not exceed the maximum patient capacity of 60. This bill prohibits a center from providing services to a minor for more than 12 hours a day and from providing services other than those provided to medically dependent or technologically dependent minors. Further, an admission to a center must not sup plant the right to a medicaid private duty nursing benefit. Transportation Services This bill requires the department to establish minimum standards for transportation services for the minor, including allowing a center to determine the schedule of transportation services and what healthcare provider must be present during transportatio n. However, the department must allow a minor's parent or legal guardian to decline a center's transportation services. This bill prohibits the department from requiring a care plan or physician's order to document a minor's need for transportation services to the center. Further, the department is prohibited from considering transportation services as nursing services i ncluded in the minor's care plan. Standards for Operating a Center This bill requires the department to establish minimum standards for operating a center, including all of the following:  Standards relating to the provision of family-centered basic services that include individualized medical, developmental, and family training services. As used in this bill, "" b asic services"" includes the caregiver training needs of a medically dependent or technologically dependent minor's parent or legal guardian and the development, implementation, and monitoring of a comprehensive protocol of care that (i) is provided to a medically dependent or technologically dependent minor; (ii) is developed in conjunction with the minor's parent or legal guardian; and (iii) specifies the medical, nursing, psychosocial, therapeutic, and developmental services required by the minor served.  Minimum building construction, renovation, and maintenance standards based on the size of the building and the number of minors served.  Standards relating to the minimum number of and qualifications required for personnel who provide personal care or basic services to the minors served.  Standards relating to the sanitary conditions within a center and its surroundings, including water supply, sewage disposal, food handling, and general hygiene.  Standards relating to the programs offered by the center to promote and maintain the health and development of the minors served and to meet the training needs of the minors' parents or legal guardians .  Standards relating to physician-prescribed supportive services .  Standards relating to the maintenance of patient medical records and program records in accordance with state and federal law and with accepted professional standards and practices .  Standards relating to transportation services . Closing of a Center As early as practicable prior to permanent closure, this bill requires a center to provide notice of the permanent closure to each enrolled minor. Such notice may be provided by a written or electronic communication, by posting the notice at the center, or by a public posting that the center deems an appropriate means for communication. An ""enrolled minor"" is a minor who is currently enrolled at a cente r and for whom tuition or attendance fees are being paid; who has attended the center within the last 90 calendar days; or who is currently on a wait list for enrollment at the center. Miscellaneous Requirements This bill requires each center to maintain medical and other records at the center. Any employee, subcontractor, or volunteer at a center must undergo a criminal background check. This bill generally prohibits the department from interfering with the authority of a parent or legal guardian of a minor at a center to make decisions regarding the treatment provided. However, the department may limit the maximum number of authorized services provided to a minor at the center. TENNCARE COVERAGE This bill requires the bureau of TennCare to provide coverage and benefits for an enrollee for services rendered at a center, subject to approval by the federal centers for medicare and medicaid services. No later than December 31, 2026, the director of TennCare must submit a request for waiver from the federal centers for medicare and medicaid services to effectuate this requirement. RULEMAKING This bill authorizes the department of disability and aging to promulgate rules to effectuate this bill."