S.F. _____ Section 1. NEW SECTION . 144F.1 Definitions. 1 As used in this chapter, unless the context otherwise 2 requires: 3 1. “After-care assistance” means any assistance provided 4 by a caregiver to a patient following the patient’s discharge 5 from a hospital that is related to the patient’s condition 6 at the time of discharge, including but not limited to 7 assisting with basic activities of daily living, assisting 8 with instrumental activities of daily living, and performing 9 other tasks including but not limited to managing wound care, 10 assisting in the administering of medications, and operating 11 medical equipment, as determined to be appropriate by the 12 patient’s discharging physician or other licensed health care 13 professional. 14 2. “Caregiver” means any individual designated as a 15 caregiver by a patient who provides after-care assistance to a 16 patient in the patient’s residence. “Caregiver” includes but is 17 not limited to a relative, spouse, partner, friend, or neighbor 18 who has a significant relationship with the patient. 19 3. “Discharge” means a patient’s exit or release from a 20 hospital to the patient’s residence following an inpatient 21 admission. 22 4. “Entry” means a patient’s admission into a hospital for 23 the purposes of receiving inpatient medical care. 24 5. “Facility” means a health care facility as defined in 25 section 135C.1, an elder group home as defined in section 26 231B.1, or an assisted living program as defined in section 27 231C.2. 28 6. “Hospital” means a licensed hospital as defined in 29 section 135B.1. 30 7. “Residence” means the dwelling that the patient considers 31 to be the patient’s home. “Residence” does not include any 32 rehabilitation facility, hospital, nursing home, assisted 33 living facility, or group home licensed by the department of 34 inspections and appeals. 35 -1- LSB 5912XC (1) 87 pf/rh 1/ 7

S.F. _____ Sec. 2. NEW SECTION . 144F.2 Caregiver —— opportunity to 1 designate. 2 1. a. A hospital shall provide each patient or, if 3 applicable, the patient’s legal guardian with an opportunity 4 to designate at least one caregiver within twenty-four hours 5 following the patient’s entry into a hospital, and prior to 6 the patient’s discharge or transfer to another hospital or 7 facility. 8 b. If the patient is unconscious or otherwise incapacitated 9 upon entry into the hospital, the hospital shall provide the 10 patient or the patient’s legal guardian with an opportunity to 11 designate a caregiver within twenty-four hours following the 12 patient’s recovery of consciousness or capacity. 13 c. If the patient or legal guardian declines to designate 14 a caregiver, the hospital shall promptly document this 15 declination in the patient’s medical record. 16 d. If the patient or the patient’s legal guardian designates 17 an individual as a caregiver, all of the following shall apply: 18 (1) The hospital shall promptly request the written consent 19 of the patient or the patient’s legal guardian to release 20 medical information to the patient’s caregiver following the 21 hospital’s established procedures for releasing personal health 22 information and in compliance with all federal and state 23 laws. If the patient or the patient’s legal guardian declines 24 to consent to release medical information to the patient’s 25 caregiver, the hospital shall not be required to provide notice 26 to the caregiver under section 144F.3 or to provide information 27 contained in the patient’s discharge plan to the caregiver 28 under section 144F.4. 29 (2) The hospital shall record the patient’s designation of 30 caregiver, the relationship of the caregiver to the patient, 31 and the name, telephone number, and address of the patient’s 32 caregiver in the patient’s medical record. 33 e. A patient or the patient’s legal guardian may elect to 34 change the designation of the patient’s caregiver at any time, 35 -2- LSB 5912XC (1) 87 pf/rh 2/ 7

S.F. _____ and the hospital shall record such change in the patient’s 1 medical record prior to the patient’s discharge. 2 2. The designation of a caregiver by a patient or a 3 patient’s legal guardian does not obligate the designated 4 individual to perform any after-care assistance for the 5 patient. 6 3. This section shall not be construed to require a patient 7 or a patient’s legal guardian to designate any individual as a 8 caregiver. 9 Sec. 3. NEW SECTION . 144F.3 Notification of caregiver. 10 A hospital shall notify the patient’s caregiver of the 11 patient’s discharge or transfer to another hospital or facility 12 as soon as possible upon issuance of a discharge or transfer 13 order by the patient’s attending physician and prior to the 14 patient’s actual discharge or transfer to another hospital or 15 facility. If the hospital is unable to contact the caregiver, 16 the lack of contact shall not interfere with, delay, or 17 otherwise affect the medical care provided to the patient, or 18 an appropriate discharge or transfer of the patient. 19 Sec. 4. NEW SECTION . 144F.4 Instructions to caregiver. 20 1. a. As soon as possible and prior to a patient’s 21 discharge from a hospital, the hospital shall consult with the 22 caregiver along with the patient regarding the caregiver’s 23 capabilities and limitations and issue a discharge plan that 24 describes the patient’s after-care assistance needs at the 25 patient’s residence. At a minimum, the discharge plan shall 26 include: 27 (1) The name and contact information of the caregiver. 28 (2) A description of all after-care assistance tasks 29 necessary to maintain the patient’s ability to reside at the 30 patient’s residence. 31 (3) Contact information for any health care, community 32 resource, and long-term services and supports necessary to 33 successfully carry out the patient’s discharge plan. 34 b. If the hospital is unable to contact the caregiver, 35 -3- LSB 5912XC (1) 87 pf/rh 3/ 7

S.F. _____ the lack of contact shall not interfere with, delay, or 1 otherwise affect the medical care provided to the patient, or 2 an appropriate discharge or transfer of the patient. 3 2. The hospital issuing the discharge plan shall offer 4 to provide a caregiver with instructions for all after-care 5 assistance tasks described in the discharge plan. At a 6 minimum, this instruction shall include: 7 a. A live demonstration or video instruction of the 8 after-care tasks, performed by a hospital employee or 9 an individual with whom the hospital has a contractual 10 relationship, who has the appropriate education and competency 11 in the task to be performed and is authorized to perform the 12 task, in a culturally-competent manner and in accordance with 13 the hospital’s requirements to provide language access services 14 under state and federal law. 15 b. An opportunity for the caregiver to ask questions about 16 the after-care assistance tasks. 17 c. Answers to the caregiver’s questions provided in 18 a culturally-competent manner and in accordance with the 19 hospital’s requirements to provide language access services 20 under state and federal law. 21 Sec. 5. NEW SECTION . 144F.5 Adoption of rules. 22 The department of inspections and appeals, in consultation 23 with the department of public health, may adopt rules pursuant 24 to chapter 17A to administer this chapter including but not 25 limited to rules to further define the content and scope of any 26 instructions provided to caregivers under this chapter. 27 Sec. 6. NEW SECTION . 144F.6 Construction of chapter 28 relative to other health care directive. 29 Nothing in this chapter shall be construed to interfere with 30 the rights of an agent operating under a valid durable power of 31 attorney for health care pursuant to chapter 144B. 32 Sec. 7. NEW SECTION . 144F.7 Limitations. 33 1. Nothing in this chapter shall be construed to create 34 a private right of action against a hospital, a hospital 35 -4- LSB 5912XC (1) 87 pf/rh 4/ 7

S.F. _____ employee, or any consultant or contractor with whom a hospital 1 has a contractual relationship, or to limit or otherwise 2 supersede or replace existing rights or remedies under any 3 other provision of law. 4 2. Nothing in this chapter shall delay the appropriate 5 discharge or transfer of a patient. 6 3. Nothing in this chapter shall be construed to interfere 7 with or supersede a health care provider’s instructions 8 regarding a Medicare-certified home health agency or any other 9 postacute care provider. 10 4. Nothing in this chapter shall be construed to grant 11 decision-making authority to a caregiver to determine the type 12 of provider or provider of the patient’s posthospital care as 13 specified in the patient’s discharge plan. 14 EXPLANATION 15 The inclusion of this explanation does not constitute agreement with 16 the explanation’s substance by the members of the general assembly. 17 This bill relates to the designation of a caregiver relative 18 to an inpatient admission of a patient to a hospital to 19 provide after-care assistance to the patient upon discharge 20 of the patient to the patient’s residence. The bill provides 21 definitions used in the new Code chapter 144F, including 22 “after-care assistance”, “caregiver”, “discharge”, “entry”, 23 “facility”, “hospital”, and “residence”. 24 The bill requires a hospital to provide each patient or, if 25 applicable, the patient’s legal guardian, with an opportunity 26 to designate at least one caregiver following the patient’s 27 entry into a hospital, and prior to the patient’s discharge 28 or transfer to another hospital or facility, and provides for 29 situations in which the patient is unconscious or otherwise 30 incapacitated or if the patient or patient’s legal guardian 31 declines to designate a caregiver. If a patient or patient’s 32 legal guardian designates a caregiver, the hospital is required 33 to promptly request the written consent of the patient or the 34 patient’s legal guardian to release medical information to 35 -5- LSB 5912XC (1) 87 pf/rh 5/ 7

S.F. _____ the patient’s caregiver following the hospital’s established 1 procedures and in compliance with all federal and state 2 laws. If the patient or the patient’s legal guardian declines 3 to consent to release medical information to the patient’s 4 caregiver, the hospital is not required to provide notification 5 to the caregiver or to provide information contained in the 6 patient’s discharge plan to the caregiver. The hospital is 7 required to record the patient’s designation of caregiver, the 8 relationship of the caregiver to the patient, and the name, 9 telephone number, and address of the patient’s caregiver in 10 the patient’s medical record. The bill allows for a change in 11 the caregiver designation by a patient or the patient’s legal 12 guardian at any time. The bill provides that the designation 13 of a caregiver by a patient or a patient’s legal guardian 14 does not obligate the designated individual to perform any 15 after-care assistance for the patient and that the provisions 16 of the bill are not to be construed to require a patient or 17 a patient’s legal guardian to designate any individual as a 18 caregiver. 19 Under the bill, a hospital is required to notify the 20 patient’s caregiver of the patient’s discharge or transfer to 21 another hospital or facility as soon as possible upon issuance 22 of a discharge or transfer order by the patient’s attending 23 physician and prior to the patient’s actual discharge or 24 transfer to another hospital or facility. If the hospital is 25 unable to contact the caregiver, the lack of contact shall not 26 interfere with, delay, or otherwise affect the medical care 27 provided to the patient, or an appropriate discharge of the 28 patient. 29 Under the bill, as soon as possible and prior to a patient’s 30 discharge from a hospital, the hospital is required to consult 31 with the caregiver along with the patient regarding the 32 caregiver’s capabilities and limitations and issue a discharge 33 plan that describes the patient’s after-care assistance needs 34 at the patient’s residence. The bill also requires specified 35 -6- LSB 5912XC (1) 87 pf/rh 6/ 7

S.F. _____ minimum instructions to be provided to the caregiver. 1 The bill directs the department of inspections and appeals 2 to adopt rules, in cooperation with the department of public 3 health, to administer the bill. The bill is not to be 4 construed to interfere with the rights of an agent operating 5 under a valid durable power of attorney for health care; 6 is not to be construed to create a private right of action 7 against a hospital, a hospital employee, or any consultant or 8 contractor with whom a hospital has a contractual relationship, 9 or to otherwise supersede or replace existing rights or 10 remedies under any other provision of law; shall not delay 11 the appropriate discharge or transfer of a patient; is not 12 to be construed to interfere with or supersede a health care 13 provider’s instructions regarding a Medicare-certified home 14 health agency or any other postacute care provider; and is 15 not to be construed to grant decision-making authority to a 16 caregiver to determine the type of provider or provider of 17 the patient’s posthospital care as specified in the patient’s 18 discharge plan. 19 -7- LSB 5912XC (1) 87 pf/rh 7/ 7