SB 187 - AS INTRODUCED

2015 SESSION

15-0381

01/10

SENATE BILL 187

AN ACT allowing a patient to designate a caregiver upon entry to a medical facility.

SPONSORS: Sen. Stiles, Dist 24; Sen. Reagan, Dist 17; Sen. Carson, Dist 14; Sen. Bradley, Dist 3; Sen. Feltes, Dist 15; Sen. Fuller Clark, Dist 21; Rep. Sherman, Rock 24; Rep. McMahon, Rock 7; Rep. Emerson, Ches 11; Rep. Cohen, Hills 30

COMMITTEE: Health and Human Services

ANALYSIS

This bill allows a patient to designate a caregiver upon entry to a hospital. Under this bill the hospital shall instruct the caregiver relative to the after-care of a patient. The commissioner of the department of health and human services is granted rulemaking authority for the purposes of the bill.

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Explanation: Matter added to current law appears in bold italics.

Matter removed from current law appears [~~in brackets and struckthrough.~~]

Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

15-0381

01/10

STATE OF NEW HAMPSHIRE

In the Year of Our Lord Two Thousand Fifteen

AN ACT allowing a patient to designate a caregiver upon entry to a medical facility.

Be it Enacted by the Senate and House of Representatives in General Court convened:

1 Statement of Intent; Findings.

I. The general court hereby finds:

(a) At any given time, a large number of New Hampshire citizens provide varying degrees of unreimbursed care to adults with limitations in daily activities. Caregivers are often members of the individual’s immediate family, but friends and other community members also serve as caregivers. While most caregivers are asked to assist an individual with basic activities of daily living, such as mobility, eating, and dressing, many are expected to perform complex tasks on a daily basis such as administering multiple medications, providing wound care, and operating medical equipment.

(b) Despite the vast importance of caregivers in the individual’s day-to-day care, many caregivers find that they are often left out of discussions involving a patient’s care while in the hospital and, upon the patient’s discharge, receive little to no instruction on the tasks they are expected to perform. The federal Centers for Medicare & Medicaid Services (CMS) estimates that $17,000,000,000,000 in Medicare funds is spent each year on unnecessary hospital readmissions. Additionally, hospitals desire to avoid the imposition of new readmission penalties under the federal Patient Protection and Affordable Care Act (ACA).

(c) To successfully address the challenges of a surging population of older adults and others living with chronic conditions and who have significant needs for long-term services and supports, the state must develop methods to enable caregivers to continue to support their loved ones at home and in the community, and avoid costly hospital readmissions.

II. Therefore, it is the intent of this act to enable caregivers to provide competent post-hospital care to their family and other loved ones, at minimal cost to the taxpayers of New Hampshire.

2 New Subdivision; Caregiver Advise, Record and Enable (CARE) Act. Amend RSA 151 by inserting after section 41 the following new subdivision:

Caregiver Advise, Record and Enable (CARE) Act

151:42 Definitions. In this subdivision:

I. “After-care” means any assistance provided by a caregiver to a patient under this chapter after the patient’s discharge from a hospital. Such assistance includes, but is not limited to, assisting with basic activities of daily living (ADLs), instrumental activities of daily living (IADLs), or carrying out medical/nursing tasks, such as managing wound care, assisting in administering medications, and operating medical equipment.

II. “Caregiver” means any individual duly designated as a caregiver by a patient under this chapter who provides after-care assistance to a patient living in his or her residence. A designated caregiver includes, but is not limited to, a relative, partner, friend, or neighbor who has a significant relationship with the patient.

III. “Discharge” means a patient’s exit or release from a hospital to the patient’s residence following any medical care, treatment, or observation.

IV. “Entry” means a patient’s entrance into a hospital for the purposes of medical care, treatment, or observation. A patient need not be formally admitted to a hospital for the provisions of this chapter to apply.

V. “Hospital” means a facility licensed under this chapter.

VI. “Residence” means a dwelling that the patient considers to be his or her home. A “residence” shall not include any licensed rehabilitation facility, hospital, nursing home, assisted living facility, or group home.

151:43 Opportunity to Designate a Caregiver.

I. A hospital shall provide each patient or, if applicable, the patient’s legal guardian with at least one opportunity to designate at least one caregiver no later than 24 hours following the patient’s entry into a hospital and prior to the patient’s discharge or transfer to another facility.

(a) If the patient is unconscious or otherwise incapacitated upon his or her entry into a hospital, the hospital shall provide such patient or his/her legal guardian with an opportunity to designate a caregiver within 24 hours following the patient’s recovery of his or her consciousness or capacity.

(b) If the patient or the patient’s legal guardian declines to designate a caregiver, the hospital shall promptly document this in the patient’s medical record.

(1) The hospital shall 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 all federal and state laws. If the patient or the patient’s legal guardian declines to consent to release medical information to the patient’s designated caregiver, the hospital shall not be required to provide notice to the caregiver under RSA 151:44 or provide information contained in the patient’s discharge plan under RSA 151:45.

(2) 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.

(d) A patient may elect to change his or her designated caregiver at any time, and the hospital shall record this change in the patient’s medical record within 24 hours.

II. A designation of a caregiver by a patient or a patient’s legal guardian under this section shall not obligate any individual to perform any after-care tasks for any patient.

III. This section shall not be construed to require a patient or a patient’s legal guardian to designate any individual as a caregiver.

151:44 Notice to Designated Caregiver. A hospital shall notify the patient’s designated caregiver of the patient’s discharge or transfer to another hospital or facility as soon as possible and not later than 4 hours prior to the patient’s actual discharge or transfer to such facility.

151:45 Instruction to Designated Caregiver, Rulemaking.

I. As soon as possible and not later than 24 hours prior to a patient’s discharge from a hospital, the hospital shall consult with the designated caregiver regarding the caregiver’s capabilities and limitations and issue a discharge plan that describes a patient’s after-care needs at his or her residence. At minimum, a discharge plan shall include:

(a) The name and contact information of the caregiver;

(b) A description of all after-care tasks necessary to maintain the patient’s ability to reside at home, taking into account the capabilities and limitations of the caregiver; and

(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.

II. The hospital issuing the discharge plan shall provide caregivers with instruction in all after-care tasks described in the discharge plan.

(a) At minimum, such instruction shall include:

(1) A live demonstration of the tasks performed by a hospital employee authorized to perform the after-care task, provided in a culturally competent manner and in accordance with the hospital’s requirements to provide language access services under state and federal law.

(2) An opportunity for the caregiver to ask questions about the after-care tasks.

(3) 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.

(b) Any instruction required under this paragraph shall be documented in the patient’s medical record, including, at minimum, the date, time, and contents of the instruction.

III. The commissioner of the department of health and human services shall adopt rules, pursuant to RSA 541-A, relative to:

(a) Procedures to designate and change a caregiver under RSA 151:43.

(b) Content and scope of the instruction required under paragraph II.

151:46 Applicability; Advance Directives.

I. Nothing in this subdivision shall be construed to interfere with the rights of an agent operating under a valid advance directive under RSA 137-J.

II. Any advance directive claimed to be in conflict with this subdivision shall be in existence prior to the patient’s entry into a hospital.

3 Effective Date. This act shall take effect upon its passage.