May 21, 2015, Introduced by Senator O'BRIEN and referred to the Committee on Health Policy.
A bill to allow for designation of a caregiver; to prescribe
the duties of a designated caregiver; to enable a hospital to
assist in designating a caregiver; and to prescribe the duties of
state departments and agencies.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec. 1. This act shall be known and may be cited as the
"designated caregiver act".
Sec. 3. As used in this act:
(a) "After-care assistance" means any assistance provided by a
caregiver to a patient following the patient's discharge from a
hospital that is related to the patient's condition at the time of
discharge and that does not require a licensed professional,
including, but not limited to, assisting with basic activities of
daily living, instrumental activities of daily living, and other
tasks as determined to be appropriate by the discharging health
care professional.
(b) "Attending physician" means that term as defined in
section 20102 of the public health code, 1978 PA 368, MCL
333.20102.
(c) "Caregiver" or "designated caregiver" means an individual
18 years of age or older designated as a caregiver by a patient
under this act who provides after-care assistance to a patient in
the patient's residence. Caregiver or designated caregiver
includes, but is not limited to, a relative, spouse, partner,
friend, or neighbor who has a significant relationship with the
patient.
(d) "Discharge" means a patient's exit or release from a
hospital to the patient's residence following any medical care or
treatment rendered to the patient following an inpatient admission.
(e) "Entry" means a patient's admission into a hospital for
the purposes of receiving inpatient medical care.
(f) "Health care professional" means an individual licensed or
otherwise authorized to practice medicine under article 15 of the
public health code, 1978 PA 368, MCL 333.16101 to 333.18838.
(g) "Hospital" means that term as defined in section 20106 of
the public health code, 1978 PA 368, MCL 333.20106.
(h) "Residence" means the dwelling that the patient considers
to be his or her home. Residence does not include a rehabilitation
facility, hospital, nursing home, assisted living facility, or
group home.
Sec. 5. (1) A hospital shall provide each patient or, if
applicable, the patient's legal guardian with an opportunity to
designate at least 1 caregiver following the patient's entry into a
hospital, and before the patient's discharge to the patient's
residence, in a time frame that is consistent with the discharge
planning process provided by rules promulgated under this act. The
hospital shall promptly document the request in the patient's
medical record.
(2) If the patient is unconscious or otherwise incapacitated
upon entry into the hospital, the hospital shall provide the
patient or the patient's legal guardian with an opportunity to
designate a caregiver within a given time frame, at the discretion
of the attending physician, following the patient's recovery of
consciousness or capacity. The hospital shall promptly document the
attempt in the patient's medical record.
(3) If the patient or the patient's legal guardian declines to
designate a caregiver under this act, the hospital shall promptly
document that decline in the patient's medical record.
(4) If the patient or the patient's legal guardian designates
an individual as a caregiver under this act, the hospital shall do
all of the following:
(a) Promptly request the written consent of the patient or the
patient's legal guardian to release medical information to the
patient's designated caregiver following the hospital's established
procedures for releasing personal health information and in
compliance with state and federal law, including the health
insurance portability and accountability act of 1996, Public Law
104-191. If the patient or the patient's legal guardian declines to
consent to release medical information to the patient's designated
caregiver, the hospital is not required to provide notice to the
caregiver under section 7 or provide information contained in the
patient's discharge plan under section 9.
(b) The hospital shall record the patient's designation of
caregiver, the relationship of the designated caregiver to the
patient, and the name, telephone number, and address of the
patient's designated caregiver in the patient's medical record.
(5) A patient or the patient's legal guardian may elect to
change the patient's designated caregiver in the event that the
designated caregiver becomes incapacitated, and the hospital must
record the change in the patient's medical record before the
patient's discharge.
(6) This does not require a patient or a patient's legal
guardian to designate an individual as a caregiver.
(7) A designation of a caregiver by a patient or a patient's
legal guardian does not obligate the designated individual to
perform any after-care assistance for the patient.
(8) If the patient is a minor child and the parents of the
patient are divorced, the custodial parent has the authority to
designate a caregiver. If the parents have joint custody of the
patient, the parents shall jointly designate the caregiver.
Sec. 7. A hospital shall notify the patient's designated
caregiver of the patient's discharge or transfer to another
facility as soon as possible and, in any event, upon issuance of a
discharge order by the patient's attending physician. If the
hospital is unable to contact the designated caregiver, the lack of
contact shall not interfere with, delay, or otherwise affect the
medical care provided to the patient, or an appropriate discharge
of the patient. The hospital shall promptly document the attempt in
the patient's medical record.
Sec. 9. (1) As soon as possible before a patient's discharge
from a hospital to the patient's residence, the hospital shall
consult with the designated caregiver and issue a discharge plan
that describes a patient's after-care assistance needs, if any, at
the patient's residence. The consultation and issuance of a
discharge plan shall occur on a schedule that takes into
consideration the severity of the patient's condition, the setting
in which care is to be delivered, and the urgency of the need for
caregiver services. If the hospital is unable to contact the
designated caregiver, the lack of contact shall not interfere with,
delay, or otherwise affect the medical care provided to the
patient, or an appropriate discharge of the patient. The hospital
shall promptly document the attempt in the patient's medical
record. At a minimum, the discharge plan shall include all of the
following:
(a) The name and contact information of the caregiver
designated under this act.
(b) A description of all after-care assistance tasks necessary
to maintain the patient's ability to reside at home.
(c) Contact information for any health care, community
resources, and long-term services and supports necessary to
successfully carry out the patient's discharge plan, and contact
information for a hospital employee who can respond to questions
about the discharge plan after the instruction provided according
to subsection (2).
(2) The hospital issuing the discharge plan must provide
caregivers with instructions in all after-care assistance tasks
described in the discharge plan. Training and instructions for
caregivers may be conducted in person or through video technology,
at the discretion of the caregiver. Any training or instructions
provided to a caregiver shall be provided in nontechnical language,
to the extent possible. At a minimum, this instruction shall
include all of the following:
(a) A live or recorded demonstration of the tasks performed by
an individual designated by the hospital, who is authorized to
perform the after-care assistance task, and who is able to perform
the demonstration in a culturally competent manner and in
accordance with the hospital's requirements to provide language
access services under state and federal law.
(b) An opportunity for the caregiver to ask questions about
the after-care assistance tasks.
(c) Answers to the caregiver's questions provided in a
culturally competent manner and in accordance with the hospital's
requirements to provide language access services under state and
federal law.
(3) Instruction required under this act shall be documented in
the patient's medical record, including, at a minimum, the date,
time, and contents of the instruction.
Sec. 11. (1) This act does not interfere with the rights of an
agent operating under a valid advance directive.
(2) A patient may designate a caregiver in an advance
directive.
Sec. 13. (1) This act does not create a private right of
action against a hospital, a hospital employee, or a consultant or
contractor with whom a hospital has a contractual relationship.
(2) A hospital, a hospital employee, or a consultant or
contractor with whom a hospital has a contractual relationship
shall not be held liable, in any way, for the services rendered or
not rendered by the caregiver to the patient at the patient's
residence.
(3) This act does not obviate the obligation of an insurance
company, health service corporation, hospital service corporation,
medical service corporation, health maintenance organization, or
any other entity issuing health benefits plans to provide coverage
required under a health benefits plan.
(4) A caregiver shall not be reimbursed by any government or
commercial payer for after-care assistance that is provided under
this act.
(5) This act does not impact, impede, or otherwise disrupt or
reduce the reimbursement obligations of an insurance company,
health service corporation, hospital service corporation, medical
service corporation, health maintenance organization, or any other
entity issuing health benefits plans.
Sec. 15. This act does not delay the discharge of a patient or
the transfer of a patient from a hospital to another facility.
Sec. 17. The department of health and human services shall
promulgate rules to implement this act according to the
administrative procedures act of 1969, 1969 PA 306, MCL 24.201 to
24.328.
Enacting section 1. This act takes effect 90 days after the
date it is enacted into law.