Tracking #2008-00137
FA/P 4/4/08, eff. 6/1/08

I:/07121701.rtf
[I:/07121701.doc]

(12 CCR 2510-1)

[Instructions:  Insert statement of basis and purpose before line 964464.]
Revisions to Sections 10.150, 10.410.1, 10.710.2, 10.720.2, 10.730.2, 10.730.3, 10.730.4, 10.730.8, and 10.930 through 10.940.2 were final adoption following publication at the 4/4/2008 State Board meeting, with an effective date of 6/1/2008 (Rule-making# 07-12-17-1). Statement of Basis and Purpose and specific statutory authority for these revisions were incorporated by reference into the rule. These materials are available for review by the public during normal working hours at the Colorado Department of Human Services, Boards and Commissions Division, State Board Administration. 

_________

[Instructions:  Replace line 964548. ]
10.150  DEFINITIONS [Rev. eff. 6/1/08] 
===

[Instructions:  Delete line 964628. ]
[  ] 
===

________

[Instructions:  Replace lines 965197 through 965212. ]
10.410.1  Prohibition of Direct Services [Rev. eff. 6/1/08]
Except for the services described below, or where a waiver is granted by the SUA, AAAs shall award funds by grant or contract to community service provider agencies and organizations.
A.  Supportive Services
The Area Agency on Aging (AAA) shall not directly provide supportive services, nutrition services, in-home services, or disease prevention and health promotion services unless, in the judgment of the State Unit on Aging (SUA):
1.  Provision of the services by the AAA is necessary to assure an adequate supply of services; or,
2.  The services are directly related to AAA administrative functions; or,
3.  Services of comparable quality can be provided more economically by the AAA.
B.  Administrative Services
Services and activities directly related to AAA administrative functions shall include, but not be limited to:
1.  Advocacy;
2.  Coordination;
3.  Program development;
4.  Information and assistance services;
5.  Outreach;
6.  Needs assessment;
7.  Training; and,
8.  Case Management.
C.  Long-Term Care Ombudsman Program Services
Long-Term Care Ombudsman Program services may be provided as a direct AAA service without a waiver. 

________

[Instructions:  Replace line 965794. ]
10.710.2  Requirements of the Colorado LTC Ombudsman Program [Rev. eff. 6/1/08]
===

[Instructions:  Replace lines 965826 through 965840. ]
V.  Prepare an annual report:
1.  Describing the activities carried out by the CLTCO in the year for which the report is being prepared;
2.  Containing and analyzing data collected as described at Section 10.730.4;
3.  Evaluating the issues or problems experienced by, and the complaints made by, or on behalf of, residents;
4.  Analyzing the success of the program including success in providing services to residents in facilities as described at Section 10.720.2, L, and in the policies and procedures established by the SUA and the CLTCO; 
5.  Identifying of barriers that prevent optimal operation of the program; and,
6.  Providing policy, regulatory, and legislative recommendations to:
a.  Solve identified problems; and,
b.  Resolve complaints; and,
c.  Improve the quality of care and life for residents; and,
d.  Protect the health, safety, welfare, and rights of residents; and,
e.  Remove barriers to optimal operation of the program and to improve the quality of care and life in long-term care facilities.
7.  Providing recommendations of program or policy changes.
W.  Make the annual report available to the public and submit copies to the Governor, the State legislature, the State agency responsible for licensing or certifying long-term care facilities, the AAA, and other appropriate governmental entities as directed by the SUA; and,
X.  Any other duties and functions assigned to the CLTCO by the SUA. 
_________

[Instructions:  Replace lines 965853 through 965880. ]
10.720.2  Requirements of Local LTC Ombudsman [Rev. eff. 6/1/08]
The Local LTC Ombudsman shall:
A.  Carry a valid identification card issued annually and signed by the CLTCO and, present the card to obtain access to residents and the facilities records;
B.  Follow these rules and the policies and procedures established by the CLTCO;
C.  Provide services to protect the health, safety, welfare, and rights of residents;
D.  Ensure residents in the service area of the Local LTC Ombudsman have timely access to representatives of the program, and timely responses to complaints and requests for assistance;
E.  Receive, investigate, and resolve complaints:
1.  Made by or on behalf of residents that relate to actions, inactions or decisions that may adversely affect the health, safety, welfare, or rights of the residents; or,
2.  Referred to the CLTCO, in accordance with the OAA, these rules, and the policies and procedures established by the CLTCO.
F.  Determine an appropriate response timeframe and respond to complaints, as follows:
1.  Complaints that allege immediate risk of losing life or limb due to abuse, medical emergency, or other type of emergency shall be referred to emergency responders and/or other appropriate agencies. The ombudsman shall follow up as an "urgent" complaint.
2.  "Urgent" complaints involve: 
a.  Abuse or gross neglect that does not pose imminent risk of life or limb; or, 
b.  Possible transfer or discharge; and, 
c.  The ombudsman shall respond within three (3) working days.
3.  "Routine" complaints involve: 
a.  Quality of care; 
b.  Staffing concerns; 
c.  Care or activities preferences; or, 
d.  Other complaints that pose no immediate risk to the resident; and, 
e.  The ombudsman shall respond within five (5) working days. 
G.  Represent the interests of residents before government agencies and seek administrative, legal, and other remedies to protect the health, safety, welfare, and rights of the residents;
H.  Review and, if necessary, comment on any existing and proposed laws, regulations, and other government policies and actions that pertain to the rights and well-being of residents;
I.  Facilitate the ability of the public to comment on the laws, regulations, policies, and actions;
J.  Assist with the development of resident and family councils;
K.  Establish linkages with at least the following community agencies:
1.  County department(s) of social or human services;
2.  Mental health centers;
3.  Local health departments;
4.  Case management agencies; and,
5.  Senior services agencies.
L.  Visit, within the region it serves:
1.  At least monthly, all nursing care facilities (i.e. nursing homes) where persons who are age 60 or over reside and which are licensed or certified, including certified swing bed facilities, as defined at 10.150, offering extended care services;
2.  At least quarterly, all assisted living residences providing services to persons who are age 60 or older, which are licensed or certified.
3.  “Visit”  shall be defined as the on-site:
a.  Provision of information about LTC ombudsman services and residents’ rights to residents and, if possible, the resident’s family;
b.  Investigation of complaints; and, 
c.  Any other responsibilities in accordance with these rules.

===

[Instructions:  Replace line 965886. ]
10.730  OMBUDSMAN PROGRAM POLICY
_________

[Instructions:  Replace lines 965896 through 965910. ]
10.730.2  LTC Ombudsman Training [Rev. eff. 6/1/08]
A.  The CLTCO, in collaboration with the SUA, shall establish procedures for the training of representatives of the office, including unpaid volunteers.
B.  The training procedures shall:
1.  Specify a minimum number of hours of initial training;
2.  Specify the content of the training including, but not limited to:
a.  Federal, State, and local laws, regulations, and policies with respect to long-term care facilities in Colorado; and,
b.  Investigative techniques; and,
c.  Other matters as the CLTCO, in collaboration with the SUA, deems appropriate.
3.  Specify an annual number of hours of in-service training for all designated or certified representatives.
C.  The CLTCO shall prohibit any representative, including employees or volunteers of Local LTC Ombudsman programs, from carrying out activities described at Section 10.710.2, unless the representative:
1.  Has received the training required by the CLTCO policy and procedures manual; and,
2.  Has been certified by the CLTCO as qualified to carry out the activity on behalf of the CLTCO.
10.730.3  Access [Rev. eff. 6/1/08] 
Representatives of the CLTCO, including local LTC ombudsmen, shall have access to: 
A.  Licensed long-term care facilities and residents, including the following:

===

[Instructions:  Replace line 965924. ]
10.730.4  Reporting [Rev. eff. 6/1/08] 
===

[Instructions:  Replace lines 965935 through 965939. ]
C.  The data shall be submitted to the SUA at time periods specified by the SUA and reported to State and Federal entities that the SUA determines to be appropriate, including: 
1.  The Assistant Secretary of the Department of Health and Human Services; and,
2.  The National Long-Term Care Ombudsman Resource Center. 

__________

[Instructions:  Replace lines 965962 through 965969. ]
10.730.8  Disclosure [Rev. eff. 6/1/08]
A.  The SUA, in collaboration with the CLTCO, shall establish procedures for disclosure by the CLTCO and Local LTC Ombudsman of files maintained by the program, including records described at Section 10.730.3 and Section 10.730.4.
B.  Such files and records shall be disclosed only at the discretion of the CLTCO (or the person designated by the CLTCO to disclose the files and records).
C.  The disclosure of the identity of any complainant or resident with respect to whom the CLTCO maintains such files or records shall be prohibited unless:
1.  The complainant or resident, or his/her legal representative, consents to the disclosure and the consent is given in writing;
2.  The complainant or resident gives consent orally and the consent is documented contemporaneously in a writing made by a representative of the CLTCO in accordance with requirements established by the SUA; or,
3.  The disclosure is required by court order.
D.  Disclosure of protected health information by the CLTCO to other entities and written authorizations of disclosure shall meet all of the requirements of Section 10.140 of these rules and any CLTCO policies and procedures.

_________

[Instructions:  Replace lines 966126 through 966150. ]
10.930  COMPLAINTS CONCERNING LOCAL LONG-TERM CARE (LTC) OMBUDSMAN PROGRAM [Rev. eff. 6/1/08]
A.  Complaints made involving actions or inactions by a local LTC ombudsman or regarding the local LTC ombudsman program shall be made with the appropriate AAA.
B.  The AAA Director shall investigate and resolve the complaint.
C.  The complainant shall be notified, in writing, by the AAA Director of the complaint resolution within thirty (30) calendar days of receipt of the complaint.  This notice shall include:
1.  A summary of the concern or issue;
2.  The results of the investigation into the complaint and the resolution of the concern; and,
3.  Notification to the complainant of his/her right to request a review of the decision if he/she is dissatisfied with the resolution, and instructions for requesting a review.
D.  If the complainant is dissatisfied with the resolution by the AAA, a written request for review of the resolution may be made with the Colorado Long-Term Care Ombudsman (CLTCO) within fifteen (15) working days of the decision. 
E.  The CLTCO shall respond to the complainant with a decision within thirty (30) calendar days of the receipt of the request. This response shall include notice that the SUA director may review the decision of the CLTCO, upon request of the complainant. 
F.  If the complainant is dissatisfied with the complaint resolution by the CLTCO, a written request for review of the resolution may be made with the SUA director within fifteen (15) working days of the CLTCO's response. 
G.  The SUA Director or designee shall complete a review of the complaint and complaint resolution, including all pertinent documentation or new information that may be available, and provide a written response to the complainant within thirty (30) calendar days of receipt of the request. This response shall include notice that the SUA director's decision is final.
10.940  COMPLAINTS CONCERNING THE COLORADO LONG-TERM CARE OMBUDSMAN (CLTCO) [Rev. eff. 6/1/08]
A.  Complaints made involving actions or inactions by the CLTCO shall be filed with SUA within thirty (30) calendar days of adverse action.
B.  The SUA shall investigate and resolve the complaint.
C.  The complainant shall be notified in writing of the resolution within thirty (30) days. This notice shall include:
1.  A summary of the concern or issue;
2.  The results of the investigation into the complaint and the resolution of the concern; and,
3.  Notice that the decision of the SUA director is final.