Senate File 465 - Introduced
SENATE FILE
BY COMMITTEE ON HUMAN
RESOURCES
(SUCCESSOR TO SSB
1182)
A BILL FOR
1 An Act relating to the designation of a caregiver relating to a
2 patient's inpatient stay at a hospital.
3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
TLSB 2129SV (3) 86
pf/nh
PAG LIN
1 1 Section 1. NEW SECTION. 144E.1 Definitions.
1 2 As used in this chapter, unless the context otherwise
1 3 requires:
1 4 1. "After=care assistance" means any assistance provided
1 5 by a caregiver to a patient following the patient's discharge
1 6 from a hospital that is related to the patient's condition
1 7 at the time of discharge, including but not limited to
1 8 assisting with basic activities of daily living, assisting
1 9 with instrumental activities of daily living, and performing
1 10 other tasks including but not limited to managing wound care,
1 11 assisting in the administering of medications, and operating
1 12 medical equipment, as determined to be appropriate by the
1 13 patient's discharging physician or other licensed health care
1 14 professional.
1 15 2. "Caregiver" means any individual designated as a
1 16 caregiver by a patient who provides after=care assistance to a
1 17 patient in the patient's residence. "Caregiver" includes but is
1 18 not limited to a relative, spouse, partner, friend, or neighbor
1 19 who has a significant relationship with the patient.
1 20 3. "Discharge" means a patient's exit or release from a
1 21 hospital to the patient's residence following an inpatient
1 22 admission.
1 23 4. "Entry" means a patient's admission into a hospital for
1 24 the purposes of receiving inpatient medical care.
1 25 5. "Facility" means a health care facility as defined in
1 26 section 135C.1, an elder group home as defined in section
1 27 231B.1, or an assisted living program as defined in section
1 28 231C.2.
1 29 6. "Hospital" means a licensed hospital as defined in
1 30 section 135B.1.
1 31 7. "Residence" means the dwelling that the patient considers
1 32 to be the patient's home. "Residence" does not include any
1 33 rehabilitation facility, hospital, nursing home, assisted
1 34 living facility, or group home licensed by the department of
1 35 inspections and appeals.
2 1 Sec. 2. NEW SECTION. 144E.2 Caregiver == opportunity to
2 2 designate.
2 3 1. a. A hospital shall provide each patient or, if
2 4 applicable, the patient's legal guardian with an opportunity
2 5 to designate at least one caregiver within twenty=four hours
2 6 following the patient's entry into a hospital, and prior to
2 7 the patient's discharge or transfer to another hospital or
2 8 facility.
2 9 b. If the patient is unconscious or otherwise incapacitated
2 10 upon entry into the hospital, the hospital shall provide the
2 11 patient or the patient's legal guardian with an opportunity to
2 12 designate a caregiver within twenty=four hours following the
2 13 patient's recovery of consciousness or capacity.
2 14 c. If the patient or legal guardian declines to designate
2 15 a caregiver, the hospital shall promptly document this
2 16 declination in the patient's medical record.
2 17 d. If the patient or the patient's legal guardian designates
2 18 an individual as a caregiver, all of the following shall apply:
2 19 (1) The hospital shall promptly request the written consent
2 20 of the patient or the patient's legal guardian to release
2 21 medical information to the patient's caregiver following the
2 22 hospital's established procedures for releasing personal health
2 23 information and in compliance with all federal and state
2 24 laws. If the patient or the patient's legal guardian declines
2 25 to consent to release medical information to the patient's
2 26 caregiver, the hospital shall not be required to provide notice
2 27 to the caregiver under section 144E.3 or to provide information
2 28 contained in the patient's discharge plan to the caregiver
2 29 under section 144E.4.
2 30 (2) The hospital shall record the patient's designation of
2 31 caregiver, the relationship of the caregiver to the patient,
2 32 and the name, telephone number, and address of the patient's
2 33 caregiver in the patient's medical record.
2 34 e. A patient or the patient's legal guardian may elect to
2 35 change the designation of the patient's caregiver at any time,
3 1 and the hospital shall record such change in the patient's
3 2 medical record prior to the patient's discharge.
3 3 2. The designation of a caregiver by a patient or a
3 4 patient's legal guardian does not obligate the designated
3 5 individual to perform any after=care assistance for the
3 6 patient.
3 7 3. This section shall not be construed to require a patient
3 8 or a patient's legal guardian to designate any individual as a
3 9 caregiver.
3 10 Sec. 3. NEW SECTION. 144E.3 Notification of caregiver.
3 11 A hospital shall notify the patient's caregiver of the
3 12 patient's discharge or transfer to another hospital or facility
3 13 as soon as possible upon issuance of a discharge or transfer
3 14 order by the patient's attending physician and prior to the
3 15 patient's actual discharge or transfer to another hospital or
3 16 facility. If the hospital is unable to contact the caregiver,
3 17 the lack of contact shall not interfere with, delay, or
3 18 otherwise affect the medical care provided to the patient, or
3 19 an appropriate discharge or transfer of the patient.
3 20 Sec. 4. NEW SECTION. 144E.4 Instructions to caregiver.
3 21 1. a. As soon as possible and prior to a patient's
3 22 discharge from a hospital, the hospital shall consult with the
3 23 caregiver along with the patient regarding the caregiver's
3 24 capabilities and limitations and issue a discharge plan that
3 25 describes the patient's after=care assistance needs at the
3 26 patient's residence. At a minimum, the discharge plan shall
3 27 include:
3 28 (1) The name and contact information of the caregiver.
3 29 (2) A description of all after=care assistance tasks
3 30 necessary to maintain the patient's ability to reside at the
3 31 patient's residence.
3 32 (3) Contact information for any health care, community
3 33 resource, and long=term services and supports necessary to
3 34 successfully carry out the patient's discharge plan.
3 35 b. If the hospital is unable to contact the caregiver,
4 1 the lack of contact shall not interfere with, delay, or
4 2 otherwise affect the medical care provided to the patient, or
4 3 an appropriate discharge or transfer of the patient.
4 4 2. The hospital issuing the discharge plan shall offer
4 5 to provide a caregiver with instructions for all after=care
4 6 assistance tasks described in the discharge plan. At a
4 7 minimum, this instruction shall include:
4 8 a. A live demonstration or video instruction of the
4 9 after=care tasks, performed by a hospital employee or
4 10 an individual with whom the hospital has a contractual
4 11 relationship, who has the appropriate education and competency
4 12 in the task to be performed and is authorized to perform the
4 13 task, in a culturally=competent manner and in accordance with
4 14 the hospital's requirements to provide language access services
4 15 under state and federal law.
4 16 b. An opportunity for the caregiver to ask questions about
4 17 the after=care assistance tasks.
4 18 c. Answers to the caregiver's questions provided in
4 19 a culturally=competent manner and in accordance with the
4 20 hospital's requirements to provide language access services
4 21 under state and federal law.
4 22 Sec. 5. NEW SECTION. 144E.5 Adoption of rules.
4 23 The department of inspections and appeals, in consultation
4 24 with the department of public health, may adopt rules pursuant
4 25 to chapter 17A to administer this chapter including but not
4 26 limited to rules to further define the content and scope of any
4 27 instructions provided to caregivers under this chapter.
4 28 Sec. 6. NEW SECTION. 144E.6 Construction of chapter
4 29 relative to other health care directive.
4 30 Nothing in this chapter shall be construed to interfere with
4 31 the rights of an agent operating under a valid durable power of
4 32 attorney for health care pursuant to chapter 144B.
4 33 Sec. 7. NEW SECTION. 144E.7 Limitations.
4 34 1. Nothing in this chapter shall be construed to create
4 35 a private right of action against a hospital, a hospital
5 1 employee, or any consultant or contractor with whom a hospital
5 2 has a contractual relationship, or to limit or otherwise
5 3 supersede or replace existing rights or remedies under any
5 4 other provision of law.
5 5 2. Nothing in this chapter shall delay the appropriate
5 6 discharge or transfer of a patient.
5 7 3. Nothing in this chapter shall be construed to interfere
5 8 with or supersede a health care provider's instructions
5 9 regarding a Medicare=certified home health agency or any other
5 10 postacute care provider.
5 11 4. Nothing in this chapter shall be construed to grant
5 12 decision=making authority to a caregiver to determine the type
5 13 of provider or provider of the patient's posthospital care as
5 14 specified in the patient's discharge plan.
5 15 EXPLANATION
5 16 The inclusion of this explanation does not constitute agreement with
5 17 the explanation's substance by the members of the general assembly.
5 18 This bill relates to the designation of a caregiver relative
5 19 to an inpatient admission of a patient to a hospital to
5 20 provide after=care assistance to the patient upon discharge
5 21 of the patient to the patient's residence. The bill provides
5 22 definitions used in the new Code chapter 144E, including
5 23 "after=care assistance", "caregiver", "discharge", "entry",
5 24 "facility", "hospital", and "residence".
5 25 The bill requires a hospital to provide each patient or, if
5 26 applicable, the patient's legal guardian, with an opportunity
5 27 to designate at least one caregiver following the patient's
5 28 entry into a hospital, and prior to the patient's discharge
5 29 or transfer to another hospital or facility, and provides for
5 30 situations in which the patient is unconscious or otherwise
5 31 incapacitated or if the patient or patient's legal guardian
5 32 declines to designate a caregiver. If a patient or patient's
5 33 legal guardian designates a caregiver, the hospital is required
5 34 to promptly request the written consent of the patient or the
5 35 patient's legal guardian to release medical information to
6 1 the patient's caregiver following the hospital's established
6 2 procedures and in compliance with all federal and state
6 3 laws. If the patient or the patient's legal guardian declines
6 4 to consent to release medical information to the patient's
6 5 caregiver, the hospital is not required to provide notification
6 6 to the caregiver or to provide information contained in the
6 7 patient's discharge plan to the caregiver. The hospital is
6 8 required to record the patient's designation of caregiver, the
6 9 relationship of the caregiver to the patient, and the name,
6 10 telephone number, and address of the patient's caregiver in
6 11 the patient's medical record. The bill allows for a change in
6 12 the caregiver designation by a patient or the patient's legal
6 13 guardian at any time. The bill provides that the designation
6 14 of a caregiver by a patient or a patient's legal guardian
6 15 does not obligate the designated individual to perform any
6 16 after=care assistance for the patient and that the provisions
6 17 of the bill are not to be construed to require a patient or
6 18 a patient's legal guardian to designate any individual as a
6 19 caregiver.
6 20 Under the bill, a hospital is required to notify the
6 21 patient's caregiver of the patient's discharge or transfer to
6 22 another hospital or facility as soon as possible upon issuance
6 23 of a discharge or transfer order by the patient's attending
6 24 physician and prior to the patient's actual discharge or
6 25 transfer to another hospital or facility. If the hospital is
6 26 unable to contact the caregiver, the lack of contact shall not
6 27 interfere with, delay, or otherwise affect the medical care
6 28 provided to the patient, or an appropriate discharge of the
6 29 patient.
6 30 Under the bill, as soon as possible and prior to a patient's
6 31 discharge from a hospital, the hospital is required to consult
6 32 with the caregiver along with the patient regarding the
6 33 caregiver's capabilities and limitations and issue a discharge
6 34 plan that describes the patient's after=care assistance needs
6 35 at the patient's residence. The bill also requires specified
7 1 minimum instructions to be provided to the caregiver.
7 2 The bill directs the department of inspections and appeals
7 3 to adopt rules, in cooperation with the department of public
7 4 health, to administer the bill. The bill is not to be
7 5 construed to interfere with the rights of an agent operating
7 6 under a valid durable power of attorney for health care;
7 7 is not to be construed to create a private right of action
7 8 against a hospital, a hospital employee, or any consultant or
7 9 contractor with whom a hospital has a contractual relationship,
7 10 or to otherwise supersede or replace existing rights or
7 11 remedies under any other provision of law; shall not delay
7 12 the appropriate discharge or transfer of a patient; is not
7 13 to be construed to interfere with or supersede a health care
7 14 provider's instructions regarding a Medicare=certified home
7 15 health agency or any other postacute care provider; and is
7 16 not to be construed to grant decision=making authority to a
7 17 caregiver to determine the type of provider or provider of
7 18 the patient's posthospital care as specified in the patient's
7 19 discharge plan.
LSB 2129SV (3) 86
pf/nh