18 Miss. Code. R. 26-2-B

Current through December 10, 2024

Section 18-26-2-B - Designation and Withdrawal of Designation of Ombudsman Programs and Ombudsmen

* Designation of Ombudsman Programs

The State Long-Term Care Facilities Ombudsman shall designate provider agencies to provide Ombudsman throughout Mississippi.

* In order to be eligible for designation by the Office of the State Long-Term Care Ombudsman (SLTCO) as a provider agency, an entity must:

a) Be a public or nonprofit entity;

b) Not be an agency or organization responsible for licensing or certifying long-term care services;

c) Not be an association of providers of long-term care or residential services for older persons;

d) Have no financial interest in a long-term care facility;

e) Have demonstrated capability to carry out the responsibilities of the provider agency;

f) Have no un-remedied conflict of interest; AND

g) Meet all contractual requirements of the Mississippi Department of Human Services.

* Where an AAA contracts with a provider agency, the designation of a new provider agency shall occur as follows:

a) The AAA shall issue a request for proposal (RFP) seeking an entity to provide LTCO services within its service area. The AAA shall request, at a minimum, the following:

* Assurance that the entity meets all the criteria for designation as a provider agency;

* The goals and objectives of such entity in providing LTCO services;

* A description of how such entity will comply with the Program Components (as outlined in Part IV of this manual).

* The staffing plan for the local long-term care ombudsman program, AND

* A description of the resources of the entity which will be provided to assist in the operation of the local LTCOP.

b) The AAA shall forward copies of all the proposals received in response to the RFP to DAAS and the State Long-Term Care Ombudsman shall review such in coordination with DAAS.

c) The AAA shall recommend an entity for designation as a provider agency to DAAS and to the SLTCO and shall provide the SLTCO with information supporting its recommendation.

d) The SLTCO shall review and consider all proposals and the recommendation of the AAA in coordination with DAAS, and shall determine the entity most appropriate to designate as the provider agency.

e) The SLTCO shall notify the AAA of the determination within thirty (30) days of receiving the AAA's recommendation.

f) The AAA shall notify the responding entities of the SLTCO decision within fifteen (15) days of receiving such notification.

g) Upon designation by the SLTCO, the AAA may enter into a contract with the provider agency for the provision of LTCO services in the relevant service area. Such contract must:

* Specify the service area;

* Require the provider agency to adhere to all applicable federal and state laws, regulations and policies, AND

* Provide that designation by the SLTCO continues for the duration of the contract and subsequently renewed contracts within the period specified within the RFP unless the provider agency is de-designated or the contract terminated for cause.

h) The execution date of the provider agency's contract with the AAA to provide LTCO services shall constitute the effective date of the designation.

i) Should the contract between the service provider and the AAA to provide LTCO services not be renewed or be terminated for any reason, the AAA shall:

* Immediately notify the SLTCO;

* Follow the steps above to designate a new provider agency as soon as possible; AND

* Follow the steps below to provide continuation of ombudsman services.

* Where the AAA seeks to serve as the provider agency, the designation of a new provider agency shall occur as follows:

a) Designation of the AAA as the provider agency where the SLTCO determines that either:

* Designation of the AAA as the provider agency is necessary to assure an adequate supply of ombudsman services; or

* Services of comparable quality can be provided more economically by the AAA.

b) The AAA shall request consideration to be designated as a provider agency and submit a proposal to the SLTCO setting forth, at a minimum, the following:

* Assurance that the entity meets all criteria for designation as a provider agency;

* The goals and objectives of such entity in providing LTCO services;

* A description of how each Program Component shall be met by such entity;

* The staffing plan for the district long-term care ombudsman program; AND

* A description of the resources of the entity which will be provided to assist in the operation of the district LTCOP.

c) The SLTCO may designate the AAA as the provider agency where:

* The AAA meets the criteria for designation;

* The AAA submits an acceptable proposal; AND

* The AAA is not otherwise prohibited from fulfilling the duties of the provider agency.

d) The SLTCO shall notify the AAA within thirty (30) days of the receipt of the proposal of its decision. If the SLTCO refuses to designate the AAA as the provider agency, the notification shall include notice of the right of the AAA to request a hearing to appeal the SLTCO's determination with the DAAS Division Director.

e) The execution of the AAA's contract with the DAAS to provide LTCO services shall be the effective date of the designation.

* Where the contract for LTCO services is not with or through the AAA, the designation of a new provider agency shall occur as follows:

a) DAAS will use a competitive bid process to seek an entity to provide LTCO services within a particular service area. The competitive bid process will identify the criteria for designation as a provider agency and shall request submission of documents supporting the entity's claim to meet these criteria.

b) DAAS will require that all of the responding entities which meet the criteria for designation develop a proposal setting forth, at a minimum, the following:

* Assurance that the entity meets all criteria for designation as a provider agency;

* The goals and objectives of such entity in providing LTCO services;

* A description of how each Program Component shall be met by such entity;

* The staffing plan for the local long-term care ombudsman program, AND

* A description of the resources of the entity which will be provided to assist in the operation of the local LTCOP.

c) SLTCO shall review each submitted proposal and shall choose the entity most appropriate to serve as the provider agency based on the submitted proposals and on the criteria for designation. The SLTCO may consult with the AAA serving the relevant service area.

d) The SLTCO shall notify the responding entities of this determination within forty-five (45) days. The notification shall be consistent with DAAS policy and procedures for entities that apply and are not chosen due to the SLTCO's determination.

e) DAAS will contract with the provider agency to provide LTCO services when appropriate. Such contract must:

* Specify the service area;

* Require the provider agency to adhere to all applicable federal and state laws, regulations and policies; AND

* Provide that designation by the SLTCO continues for the duration of the contract and subsequently renewed contracts within the period specified with the RFP unless the provider agency is de-designated by the SLTCO or the contract is terminated for cause.

f) The execution date of the provider agency's contract with DAAS to provide ombudsman services shall be the effective date of the designation.

* Withdrawal of Designation Ombudsman Program

The State Ombudsman may de-designate an entity as a provider agency for cause.

* The SLTCO may refuse to designate or may de-designate an entity as a provider agency for one of more of the following reasons:

a) Failure of the entity to continue to meet the criteria for designation;

b) Existence in the entity of an un-remedied conflict of interest with the LTCOP;

c) Deliberate failure of the entity to disclose any conflict of interest;

d) Violation of LTCO confidentiality requirements by any person employed by, supervised by, or otherwise acting as an agent of the entity;

e) Failure of the entity to provide adequate LTCO services, including but not limited to failure to perform enumerated responsibilities, failure to fill a vacant ombudsman staff position within a reasonable time, failure to submit a Local LTCOP Annual Plan for approval by the SLTCO, or failure to use funds designated for the LTCOP for LTCO services;

f) Failure of the entity to adhere to the provisions of the contract for the provision of ombudsman services, OR

g) Failure of the entity to adhere to applicable federal and state laws, regulations and policies.

* Process for withdrawal of designation of a LTCO provider agency:

a) Where an AAA contracts with a provider agency, the process to de-designate the provider agency shall be as follows:

* The SLTCO shall send notice of intent to de-designate at a specified date to the AAA and the provider agency. The notice shall include the reasons for withdrawal of designation and notice of hearing procedures of the DAAS.

* Withdrawal of designation of a provider agency shall not become effective until all appeals are exhausted.

* The AAA and SLTCO shall provide for the continuation of ombudsman services.

* The AAA shall terminate its contract for LTCO services with the provider agency.

b) Where an AAA serves as a provider agency, the process to de-designate the provider agency shall be as follows:

* The SLTCO shall send notice to de-designate at a specified date to the AAA. The notice shall include the reasons for withdrawal of designation and notice of hearing procedures of the DAAS.

* Withdrawal of designation of the AAA as a provider agency shall not become effective until all appeals are exhausted.

* The AAA and the SLTCO shall provide for the continuation of ombudsman services until designation of another entity is effective.

* DAAS will terminate the portion of the contract between the AAA and the DAAS which provides for ombudsman services.

c) Where a provider agency contracts directly with the DAAS, the process to de-designate the provider agency shall be as follows:

* SLTCO shall send notice of the intent to de-designate at a specified date to the provider agency and to the applicable AAA. The notice shall include the reasons for withdrawal of designation and notice of the hearing procedures of the DAAS.

* Withdrawal of designation of a provider agency shall not become effective until all appeals are exhausted.

* SLTCO shall provide for continuation of ombudsman services until designation of another entity is effective. The SLTCO may consult with the applicable AAA regarding the provision of services in the service area.

* DAAS will terminate its contract with the provider agency.

* Voluntary withdrawal of a provider agency:

A LTCO provider agency may voluntarily relinquish its designation by providing notice to the SLTCO and to the AAA in the relevant service area. Such notice shall be provided sixty (60) days in advance of the date of relinquishment of designation.

* Continuation of Ombudsman Services:

Where a provider agency is in the process of appealing its withdrawal of designation or has relinquished designation:

a) The provider agency, the AAA if applicable, and the SLTCO shall arrange for the provision of ombudsman services until a new provider agency is designated;

b) The provider agency shall surrender intact to the SLTCO or the SLTCO designee all LTCO case records, documentation of all LTCO activities and complaint processing as required by the ombudsman reporting system, and identification cards of all local LTCOs associated with the provider agency;

c) The provider agency shall, at the discretion of the DAAS, surrender any equipment purchased with funds designated for LTCO services; AND

d) The provider agency shall surrender the balance of any advanced state or federal monies to the AAA, or to the DAAS where the AAA serves as the provider agency.

* Designation of Long-Term Care Ombudsmen

The State Ombudsman designates individuals as ombudsmen to participate in the Long-Term Care Ombudsman Program and to represent the Office of the State Long-Term Care Ombudsman.

* Criteria for designation as an ombudsman

To be designated as a LTCO, an individual must:

a) Have demonstrated capability to carry out the responsibilities of a LTCO;

b) Be free of un-remedied conflicts of interest;

c) Meet the minimum qualifications for the applicable LTCO position;

d) Satisfactorily complete the applicable designation/certification training required as specified in said policies and procedures manual;

e) Be awarded a current designation certificate by the SLTCO; AND

f) Satisfactorily fulfill LTCO Program Components as outlined in said policies and procedures manual.

* Minimum qualifications for staff ombudsmen

a) In order to qualify for a LTCO staff position, an individual must have:

* An undergraduate degree from a four-year college or university;

* Two years of professional experience with at least one year in aging, long-term care, or related fields; AND

* A criminal background check by a local law enforcement agency. The individual shall not be hired if he or she has been convicted of any of the crimes listed under the laws related to nursing home or personal care home employees.

b) Relevant and comparable education and/or experience may be substituted at the discretion of the SLTCO. Experience may be substituted for undergraduate education on a one-to-one basis; however, the same experience cannot be used to meet both the education and experience requirements.

* Values and Skills that an Ombudsman Should Possess

Regardless of the discipline from which an ombudsman comes or the level of education and training, those working with the elderly in long-term care facilities should possess certain basic values and attitudes as well as fundamental interpersonal relationship and intervention skills. Additionally, there should be a basic set of principles which guide an ombudsman decision when providing advocacy services.

Values and Attitudes

* A genuine liking and respect for older adults, especially the frail and impaired;

* A belief in the resident's right to self-determination, privacy, confidentiality, and consent to services;

* A belief in quality of care and life;

* An ability to demonstrate commitment and take action on behalf of the frail and elderly;

* A belief and willingness to allow for the individuality of the resident unrestricted by personal belief or opinion;

* A mature attitude towards the use of power and authority;

* An understanding and acceptance of death and dying, and the ability to cope.

Skills (Ability/Aptitude)

* Develop trust and confidence between residents and their families;

* Provide personal understanding and empathy;

* Conduct active listening techniques, effective communication;

* Draw the client out, asking his preferences and actively involving him/her in the complaint investigation/resolution process;

* Mobilize interaction among many different individuals;

* Form resident and family councils;

* Mediate conflicts;

* Use support and reinforcement techniques;

* Offer professional opinions and remain impartial;

* Find resources, negotiate services, make referrals;

* Educate the resident and his family, and the community about long-term care; and

* Ability to professionally and personally bring about case closure.

* Minimum qualifications for volunteers

a) There are no minimum education or experience requirements for volunteers prior to screening and acceptance into the LTCOP. The LTCOP shall clarify responsibilities and providing training for volunteers.

b) Volunteers undergo the same training and designation process as employed Representatives of the Office.

* A volunteer shall have a criminal background check by the local law enforcement agency. The individual shall not serve as a volunteer if he or she has been convicted of any of the crimes listed under the laws related to nursing home or personal care home employees.

* Provider agency process for hiring LTCO staff

a) Prior to providing an offer of employment to an individual for the purpose of serving as an LTCO, the provider agency shall:

* Indicate to the SLTCO that the individual has a satisfactory criminal background check, AND

* Provide the SLTCO with a completed Individual Conflict of Interest Reporting Form and an opportunity to review the resume of the candidate(s) being considered for employment.

b) The SLTCO shall promptly notify the provider agency of any concerns related to the candidate's ability to meet minimum qualifications or other designation requirements.

c) If the SLTCO has concerns about the future designation of any candidate, the SLTCO may request an interview of the candidate and shall inform the provider agency of any concerns that the provider agency should consider prior to hiring the candidate(s).

* Requests for substitutions or variances

Requests for substitutions or variances related to minimum requirements must be made in writing and approved prior to the hiring or promotion of the employee in question.

* Designation of formerly designated ombudsman from Mississippi or from another state

When an individual has been designated as an LTCO previously in Mississippi but is not currently designated, or when an individual has been designated as a LTCO in another state, the SLTCO shall determine what steps are needed to qualify as a designated LTCO, by reviewing the circumstances on an individual basis and considering, at a minimum, the following criteria:

a) Context and extent of LTCO training completed, which must meet or exceed current designation/certification training requirements for Mississippi; AND

b) Need for updated and/or Mississippi-specific training;

c) Need to demonstrate competencies for the position by completing written or oral examinations; AND

d) Quality of performance of individual as an LTCO, including checking references.

* Notification of designation

The SLTCO shall send written notification of an individual's designation as a LTCO to the individual being designated, as well as to the AAA, and the provider agency in the relevant service area within thirty (30) days of the determination.

* Refusal to Designate, Suspension of Designation, or Withdrawal of Designation of an Individual as a Long-Term Care Ombudsman

The State Ombudsman may refuse to designate, may suspend designation, or may withdraw designation of an individual as an ombudsman.

* The SLTCO may refuse to designate, may suspend designation, or may de-designate an individual as an LTCO for any of the following reasons:

a) Failure of the individual to meet and/or maintain the criteria for designation;

b) Existence of an un-remedied conflict of interest;

c) Deliberate failure of the individual to disclose any conflict of interest;

d) Violation of the confidentiality requirements;

e) Failure to provide adequate and appropriate services to long-term care residents;

f) Falsifying records and/or reports;

g) Failure to adhere to the Ombudsman Code of Ethics (See Appendix A);

h) Failure to follow LTCO policies and procedures or the direction of the SLTCO (which includes failure to submit reports);

i) A change in employment duties which are incompatible with LTCO duties;

j) Separation from the LTCOP. Examples include: removal from employment by the designated provider agency, an extended absence of the LTCO preventing fulfillment of job responsibilities, provider agency's contract for the provision of LTCO services is not renewed; OR

k) Failure to act in accordance with applicable federal or state laws, regulations, and policies.

* Process for refusal to designate, suspension of designation, or withdrawal of designation of an individual as an ombudsman:

a) Prior to refusing to designate, suspending designation, or withdrawing designation an individual as a LTCO, the SLTCO shall consult with the relevant AAA and the provider agency to consider remedial actions which could be taken to avoid the refusal to designate or the withdrawal of designation.

b) The SLTCO shall provide written notice of the decision to refuse to designate, suspend designation, or de-designate an individual as a LTCO to the provider agency, the AAA if applicable, and to the Division Director of DAAS. Such notice shall:

* Specify the reasons for and the effective date of the decision, AND

* In the case of a suspension, indicate the circumstances under which the suspension will end or be reconsidered.

c) The SLTCO or the deputy SLTCO shall promptly notify the administrator of facilities which had been regularly visited by such individual of the refusal to designate, suspension of designation, or withdrawal of designation.

d) If the decision to refuse to designate, suspend designation, or de-designate an individual as a LTCO results in the absence of ombudsman services in the relevant service area, the provider agency, the AAA, and the SLTCO shall arrange for the provision of ombudsman services until a LTCO is designated.

The State Ombudsman may de-designate or issue sanctions on an AAA for failure to comply with Ombudsman Program Components.

18 Miss. Code. R. 26-2-B

Adopted 4/12/2019