HF 2289 (LSB 5912YH (1) 87)

HOUSE FILE 2289

BY  R. TAYLOR

A BILL FOR

An Act providing for the designation of a caregiver relating to a patient’s inpatient stay at a hospital.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  NEW SECTION.  144F.1  Definitions.
   As used in this chapter, unless the context otherwise requires:
   1.  “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, including but not limited to assisting with basic activities of daily living, assisting with instrumental activities of daily living, and performing other tasks including but not limited to managing wound care, assisting in the administering of medications, and operating medical equipment, as determined to be appropriate by the patient’s discharging physician or other licensed health care professional.
   2.  “Caregiver” means any individual designated as a caregiver by a patient who provides after-care assistance to a patient in the patient’s residence. “Caregiver” includes but is not limited to a relative, spouse, partner, friend, or neighbor who has a significant relationship with the patient.
   3.  “Discharge” means a patient’s exit or release from a hospital to the patient’s residence following an inpatient admission.
   4.  “Entry” means a patient’s admission into a hospital for the purposes of receiving inpatient medical care.
   5.  “Facility” means a health care facility as defined in section 135C.1, an elder group home as defined in section 231B.1, or an assisted living program as defined in section 231C.2.
   6.  “Hospital” means a licensed hospital as defined in section 135B.1.
   7.  “Residence” means the dwelling that the patient considers to be the patient’s home. “Residence” does not include any rehabilitation facility, hospital, nursing home, assisted living facility, or group home licensed by the department of inspections and appeals.
    Sec. 2.  NEW SECTION.  144F.2  Caregiver —— opportunity to designate.
   1.  a.  A hospital shall provide each patient or, if applicable, the patient’s legal guardian with an opportunity to designate at least one caregiver within twenty-four hours following the patient’s entry into a hospital, and prior to the patient’s discharge or transfer to another hospital or facility.
   b.  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 twenty-four hours following the patient’s recovery of consciousness or capacity. 
   c.  If the patient or legal guardian declines to designate a caregiver, the hospital shall promptly document this declination in the patient’s medical record.
   d.  If the patient or the patient’s legal guardian designates an individual as a caregiver, all of the following shall apply:
   (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 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 caregiver, the hospital shall not be required to provide notice to the caregiver under section 144F.3 or to provide information contained in the patient’s discharge plan to the caregiver under section 144F.4.
   (2)  The hospital shall record the patient’s designation of caregiver, the relationship of the caregiver to the patient, and the name, telephone number, and address of the patient’s caregiver in the patient’s medical record.
   e.  A patient or the patient’s legal guardian may elect to change the designation of the patient’s caregiver at any time, and the hospital shall record such change in the patient’s medical record prior to the patient’s discharge. 
   2.  The 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.
   3.  This section shall not be construed to require a patient or a patient’s legal guardian to designate any individual as a caregiver.
    Sec. 3.  NEW SECTION.  144F.3  Notification of caregiver.
    A hospital shall notify the patient’s caregiver of the patient’s discharge or transfer to another hospital or facility as soon as possible upon issuance of a discharge or transfer order by the patient’s attending physician and prior to the patient’s actual discharge or transfer to another hospital or facility. If the hospital is unable to contact the caregiver, the lack of contact shall not interfere with, delay, or otherwise affect the medical care provided to the patient, or an appropriate discharge or transfer of the patient.
    Sec. 4.  NEW SECTION.  144F.4  Instructions to caregiver.
   1.  a.  As soon as possible and prior to a patient’s discharge from a hospital, the hospital shall consult with the caregiver along with the patient regarding the caregiver’s capabilities and limitations and issue a discharge plan that describes the patient’s after-care assistance needs at the patient’s residence. At a minimum, the discharge plan shall include:
   (1)  The name and contact information of the caregiver.
   (2)  A description of all after-care assistance tasks necessary to maintain the patient’s ability to reside at the patient’s residence.
   (3)  Contact information for any health care, community resource, and long-term services and supports necessary to successfully carry out the patient’s discharge plan.
   b.  If the hospital is unable to contact the caregiver, the lack of contact shall not interfere with, delay, or otherwise affect the medical care provided to the patient, or an appropriate discharge or transfer of the patient.
   2.  The hospital issuing the discharge plan shall offer to provide a caregiver with instructions for all after-care assistance tasks described in the discharge plan. At a minimum, this instruction shall include:
   a.  A live demonstration or video instruction of the after-care tasks, performed by a hospital employee or an individual with whom the hospital has a contractual relationship, who has the appropriate education and competency in the task to be performed and is authorized to perform the task, 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.
    Sec. 5.  NEW SECTION.  144F.5  Adoption of rules.
   The department of inspections and appeals, in consultation with the department of public health, may adopt rules pursuant to chapter 17A to administer this chapter including but not limited to rules to further define the content and scope of any instructions provided to caregivers under this chapter.
    Sec. 6.  NEW SECTION.  144F.6  Construction of chapter relative to other health care directive.
   Nothing in this chapter shall be construed to interfere with the rights of an agent operating under a valid durable power of attorney for health care pursuant to chapter 144B.
    Sec. 7.  NEW SECTION.  144F.7  Limitations.
   1.  Nothing in this chapter shall be construed to create a private right of action against a hospital, a hospital employee, or any consultant or contractor with whom a hospital has a contractual relationship, or to limit or otherwise supersede or replace existing rights or remedies under any other provision of law.
   2.  Nothing in this chapter shall delay the appropriate discharge or transfer of a patient.
   3.  Nothing in this chapter shall be construed to interfere with or supersede a health care provider’s instructions regarding a Medicare-certified home health agency or any other postacute care provider.
   4.  Nothing in this chapter shall be construed to grant decision-making authority to a caregiver to determine the type of provider or provider of the patient’s posthospital care as specified in the patient’s discharge plan.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
   This bill relates to the designation of a caregiver relative to an inpatient admission of a patient to a hospital to provide after-care assistance to the patient upon discharge of the patient to the patient’s residence. The bill provides definitions used in the new Code chapter 144F, including “after-care assistance”, “caregiver”, “discharge”, “entry”, “facility”, “hospital”, and “residence”.
   The bill requires a hospital to provide each patient or, if applicable, the patient’s legal guardian, with an opportunity to designate at least one caregiver following the patient’s entry into a hospital, and prior to the patient’s discharge or transfer to another hospital or facility, and provides for situations in which the patient is unconscious or otherwise incapacitated or if the patient or patient’s legal guardian declines to designate a caregiver. If a patient or patient’s legal guardian designates a caregiver, the hospital is required to promptly request the written consent of the patient or the patient’s legal guardian to release medical information to the patient’s caregiver following the hospital’s established procedures 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 caregiver, the hospital is not required to provide notification to the caregiver or to provide information contained in the patient’s discharge plan to the caregiver. The hospital is required to record the patient’s designation of caregiver, the relationship of the caregiver to the patient, and the name, telephone number, and address of the patient’s caregiver in the patient’s medical record. The bill allows for a change in the caregiver designation by a patient or the patient’s legal guardian at any time. The bill provides that the 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 and that the provisions of the bill are not to be construed to require a patient or a patient’s legal guardian to designate any individual as a caregiver. 
   Under the bill, a hospital is required to notify the patient’s caregiver of the patient’s discharge or transfer to another hospital or facility as soon as possible upon issuance of a discharge or transfer order by the patient’s attending physician and prior to the patient’s actual discharge or transfer to another hospital or facility. If the hospital is unable to contact the 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.
   Under the bill, as soon as possible and prior to a patient’s discharge from a hospital, the hospital is required to consult with the caregiver along with the patient regarding the caregiver’s capabilities and limitations and issue a discharge plan that describes the patient’s after-care assistance needs at the patient’s residence. The bill also requires specified minimum instructions to be provided to the caregiver.
   The bill directs the department of inspections and appeals to adopt rules, in cooperation with the department of public health, to administer the bill. The bill is not to be construed to interfere with the rights of an agent operating under a valid durable power of attorney for health care; is not to be construed to create a private right of action against a hospital, a hospital employee, or any consultant or contractor with whom a hospital has a contractual relationship, or to otherwise supersede or replace existing rights or remedies under any other provision of law; shall not delay the appropriate discharge or transfer of a patient; is not to be construed to interfere with or supersede a health care provider’s instructions regarding a Medicare-certified home health agency or any other postacute care provider; and is not to be construed to grant decision-making authority to a caregiver to determine the type of provider or provider of the patient’s posthospital care as specified in the patient’s discharge plan.