MALA Annual Conference Lansing Center Lansing, MI Wednesday May 9, 2018, 10:30 a.m. Licensing Update from AFC & Camps Licensing Division Jerry Hendrick, Area Manager, Grand Rapids Jay Calewarts, Director, AFC & Camps Licensing Division

LARA/Bureau Overview Shelly Edgerton, LARA Director Larry Horvath, BCHS Bureau Director Currently there are 4 Divisions: AFC and Camps Division (includes AFC, HFA and camps) Child Care Licensing Division Federal Survey and Certification Division Health Facilities Licensing, Permits & Support Division

BCHS Organizational Overview Larry Horvath Bureau Director Mark Jansen, Director Child Care Licensing Division Jay Calewarts, Director Adult Foster Care & Camps Division Heather Hosey, Director Health Facility Licensing, Permits, and Support Division Michelle Roepke, Director Federal Survey & Certification Division Steve Gobbo Deputy Bureau Director BCHS Organizational Overview State Licensed Child Care Group Homes/Centers State Licensed Adult Foster Care Homes Adult Foster Care/Child Camps Homes for the Aged State Licensed Freestanding Surgical Outpatient Facilities Hospice Agencies & Residences Hospitals Nursing Homes Substance Use Disorder Programs Other Functions Complaint Intake Nurse Aide Training Program Nurse Aide Registry FOIA Federal Certification Ambulatory Surgical Centers Clinical Laboratory Services Comprehensive Outpatient Rehabilitation Facilities Dialysis Centers Home Health Agencies Hospice Agencies & Residences Hospitals Nursing Homes Outpatient Physical Therapy (OPT)/Speech Pathology Providers Portable X-Ray Suppliers Rural Health Clinics

Michigan Covered Providers No. of Providers Type State License Federally Certified 9,242 Child Care Homes & Centers Yes No 8,258 Clinical Laboratory Services (CLIA) 4,214 Adult Foster Care Homes 1,166 Substance Use Disorder Programs 1,054 Adult Foster Care/Child Camps 556 Home Health Agencies 460 Nursing Homes/LTC Facilities 261 Homes for the Aged 209 Dialysis Centers (ESRD) 169 Hospitals 170 Rural Health Clinics 153 Freestanding Surgical Outpatient Facilities 152 OPT/Speech Pathology Providers 142 Hospice Agencies 64 Inpatient Psychiatric Hospitals/Units 17 Hospice Residences 9 Organ Transplant Facilities 7 Portable X-Ray Providers 5 Comprehensive Outpatient Rehab (CORF) 3 Community Mental Health Centers Michigan Covered Providers (As of January 2018) Some federal oversight for organ procurement organizations (1) and federally qualified health centers (241). 52,297 Certified Nurse Aides Registered

AFC & Camps Org Chart

AFC Coverage Map

HFA Coverage Map

PA 167 of 2017 Modifies the Part 201 (General Provisions section) and 213 (Home for the Aged section) of the Public Health Code Signed into law on November 9, 2017 Took effect on February 11, 2018 PA 167 can be found at: http://www.legislature.mi.gov/documents/2017-2018/publicact/pdf/2017-PA-0167.pdf

PA 167 Changes Lower the minimum age from 60 to 55 years old Cap on Background Checks Starting 10/1/18 40 checks for facilities with fewer than 100 beds 50 checks for facilities with 100 or more beds

PA 167 Changes Redefines Supervised Personal Care 333.21302 (2) “Supervised personal care” means the direct guidance or hands-on assistance with activities of daily living offered by a facility to residents of the facility that include 2 or more of the following services provided by the facility to any resident for 30 or more consecutive days as documented in the resident’s service plan:

Supervised Personal Care (a) Direct and regular involvement by staff in assisting a resident with the administration of the resident’s prescription medications, including direct supervision of the resident taking medication in accordance with the instructions of the resident’s licensed health care professional. (b) Hands-on assistance by staff in carrying out 2 or more of the following activities of daily living: eating, toileting, bathing, grooming, dressing, transferring, and mobility. (c) Direct staff involvement in a resident’s personal and social activities or the use of devices to enhance resident safety by controlling resident egress from the facility.

Existing Facilities can be Reviewed to Board and Care Beginning on the effective date of the amendatory act that added this subsection, the bureau of fire services shall amend the rules to allow facilities in existence on or before the effective date of the amendatory act that added this subsection and continuously operating up to the time of application for a home for the aged license to be reviewed and inspected to comply with the provisions of chapter 18 or 19 or chapter 32 or 33 of the national fire protection association standard number 101.

Exemption from HFA Licensure There are now 4 ways to be exempt from HFA licensure (MCL 333.21311a) Food provider is unrelated to care or board provider or both 2) Room, board and care are related however this relationship was in effect for 2 years before applying for exemption and residents can choose care provider of their choice 3) CCRC with a licensed nursing home on campus 4) Room and care are not related and residents can choose care provider of their choice

Exemption from HFA Licensure Exemptions 1 & 2 on previous slide must be approved by December 31, 2019 (except to a successor owner, operator, or governing body…) Exemptions 3 & 4 on previous slide do not have a cut off date Department has up to 60 days to act on an exemption application HFA exemption application can be found at: http://www.michigan.gov/documents/lara/HFA_Exemption_Application_1_18_612626_7.pdf

AFC Legislation Introduced HB 5505 & HB 5506 Capacity of 1 or 2 don’t need to be licensed Raises licensing fees for first time since 1992 4 or less residents and all CMH consumers can file for an exemption Creates authority for emergency closure management Requires facility to pay for staff background checks

AFC Legislation Introduced SB 744 & SB 745 6 or less residents and all receive community living supports and/or personal care, the person(s) providing the personal care, supervision or protection are not related to the person(s) providing the room and board Modifies the Zoning Enabling Act so that these facilities must be considered residential

AFC Legislation Introduced SB 962 Would allow “co-occurring enhanced crisis residential program” to be dually licensed as and AFC and SUD program Currently only about 15 programs that would qualify for dual licensure

AFC Council Rule Review MCL 400.710(5) The rules shall be reviewed by the council not less than once every 5 years. Have begun to review of AFC special certification rules Hope to have draft AFC special certification rule changes ready for public comment by late summer/early fall Once completed, plan to review other rule sets Any proposed rule changes you may have, please send to me at calewartsj@michigan.gov

BCAL 1326-A Changes Renamed to BCAL 1326A – FP (for applicant/licensee, licensee designee, and owner, partner or director who has regular access) Adult Foster Care Licensing Information Request form BCHS-AFC 100 (for adult house hold members, administrators and responsible persons). Note that administrators and a responsible person have to be fingerprinted though the Workforce Background Check Program https://www.michigan.gov/lara/0,4601,7-154-63294_27717-320643--,00.html

BCAL 1326-A Changes

License Look-up Website Server crashed which housed and linked all reports to license look-up page IT still working to restore reports and link them to correct facility Encourage you to look-up your facility and notify us if something is missing or needs to be removed http://w1.lara.state.mi.us/AdultFosterCare

A License is Required (AFC) Provision of supervision Provision of personal care Provision of protection Provision of room and board Twenty-four hours a day Five or more days a week Two or more consecutive weeks for compensation

HCBS Requirements of HCBS and licensing can be met See joint communication on HCBS rule and licensing issue http://www.michigan.gov/mdhhs/0,5885,7-339-71547_2943-334724--,00.html Make sure a detailed assessment is completed

Questions & Answers Email: calewartsj@michigan.gov BCHS-Help@michigan.gov Website: www.michigan.gov/afchfa Lansing Office Address: 611 W. Ottawa Street Ottawa Building, 1st Floor PO Box 30664 Lansing MI, 48909