House File 2434 H-8207 Amend House File 2434 as follows: 1 1. By striking everything after the enacting clause and 2 inserting: 3 < Section 1. NEW SECTION . 144F.1 Definitions. 4 As used in this chapter, unless the context otherwise 5 requires: 6 1. “Aftercare assistance” means any assistance provided 7 by a lay caregiver to a patient following discharge of the 8 patient that are tasks directly related to the patient’s 9 condition at the time of discharge, do not require a licensed 10 professional, and are determined to be appropriate by the 11 patient’s discharging physician or other licensed health care 12 professional. 13 2. “Discharge” means the exit or release of a patient from 14 inpatient care in a hospital to the residence of the patient. 15 3. “Facility” means a health care facility as defined in 16 section 135C.1, an elder group home as defined in section 17 231B.1, or an assisted living program as defined in section 18 231C.2. 19 4. “Hospital” means a licensed hospital as defined in 20 section 135B.1. 21 5. “Lay caregiver” means an individual, eighteen years of 22 age or older, who is designated as a lay caregiver under this 23 chapter by a patient or the patient’s legal representative, and 24 who is willing and able to perform aftercare assistance for the 25 patient at the patient’s residence following discharge. 26 6. “Legal representative” means, in order of priority, 27 an attorney in fact under a durable power of attorney for 28 health care pursuant to chapter 144B or, if no durable power 29 of attorney for health care has been executed pursuant to 30 chapter 144B or if the attorney in fact is unavailable, a legal 31 guardian appointed pursuant to chapter 633. 32 7. “Patient” means an individual who is receiving or who has 33 received inpatient medical care in a hospital. 34 8. “Residence” means the dwelling that a patient considers 35 -1- HF2434.4452 (5) 87 pf/rh 1/ 5 #1.

to be the patient’s home. “Residence” does not include any 1 rehabilitation facility, hospital, or facility. 2 Sec. 2. NEW SECTION . 144F.2 Discharge policies —— 3 opportunity to designate lay caregiver. 4 1. a. A hospital shall adopt and maintain evidence-based 5 discharge policies and procedures. At a minimum, the policies 6 and procedures shall provide for an assessment of the patient’s 7 ability for self-care after discharge and, as part of the 8 assessment, shall provide a patient, or if applicable the 9 patient’s legal representative, with an opportunity to 10 designate one lay caregiver prior to discharge of the patient. 11 b. A legal representative who is an agent under a durable 12 power of attorney for health care pursuant to chapter 144B 13 shall be given the opportunity to designate a lay caregiver 14 in lieu of the patient’s designation of a lay caregiver only 15 if, consistent with chapter 144B, in the judgment of the 16 attending physician, the patient is unable to make the health 17 care decision. A legal representative who is a guardian shall 18 be given the opportunity to designate a lay caregiver in lieu 19 of the patient’s designation of a lay caregiver to the extent 20 consistent with the powers and duties granted the guardian 21 pursuant to section 633.635. 22 2. If a patient or the patient’s legal representative 23 declines to designate a lay caregiver, the hospital shall 24 document the declination in the patient’s medical record and 25 the hospital shall be deemed to be in compliance with this 26 section. 27 3. If a patient or the patient’s legal representative 28 designates a lay caregiver, the hospital shall do all of the 29 following: 30 a. Record in the patient’s medical record the designation of 31 the lay caregiver, in accordance with the hospital’s policies 32 and procedures, which may include information such as the 33 relationship of the lay caregiver to the patient, and the name, 34 telephone number, and address of the lay caregiver. 35 -2- HF2434.4452 (5) 87 pf/rh 2/ 5

b. (1) Request written consent from the patient or the 1 patient’s legal representative to release medical information 2 to the lay caregiver in accordance with the hospital’s 3 established procedures for releasing a patient’s personal 4 health information and in compliance with all applicable state 5 and federal laws. 6 (2) If a patient or the patient’s legal representative 7 declines to consent to the release of medical information to 8 the lay caregiver, the hospital is not required to provide 9 notice to the lay caregiver under section 144F.3 or to consult 10 with or provide information contained in the patient’s 11 discharge plan to the lay caregiver under section 144F.4. 12 4. A patient or the patient’s legal representative may 13 change the designation of a lay caregiver if the lay caregiver 14 becomes incapacitated. 15 5. The designation of an individual as a lay caregiver under 16 this section does not obligate the individual to perform any 17 aftercare assistance for the patient. 18 6. This section shall not be construed to require a patient 19 or the patient’s legal representative to designate a lay 20 caregiver. 21 Sec. 3. NEW SECTION . 144F.3 Notification of lay caregiver 22 of discharge or transfer. 23 If a lay caregiver is designated under section 144F.2, the 24 hospital shall, in accordance with the hospital’s established 25 policies and procedures, attempt to notify the lay caregiver 26 of the discharge of the patient or transfer of the patient to 27 another hospital or facility as soon as practicable. 28 Sec. 4. NEW SECTION . 144F.4 Aftercare assistance 29 instructions to lay caregiver. 30 1. If a lay caregiver is designated under section 144F.2, as 31 soon as practicable prior to discharge of a patient, a hospital 32 shall attempt to do all of the following: 33 a. Consult with the patient’s lay caregiver to prepare the 34 lay caregiver for the aftercare assistance the lay caregiver 35 -3- HF2434.4452 (5) 87 pf/rh 3/ 5

may provide. 1 b. Issue a discharge plan that describes the aftercare 2 assistance needs of the patient and offer to provide the lay 3 caregiver with instructions for the aftercare assistance tasks 4 described in the discharge plan and the opportunity for the lay 5 caregiver to ask questions regarding such tasks. 6 2. The inability of a hospital to consult with a patient’s 7 lay caregiver shall not interfere with, delay, or otherwise 8 affect the medical care provided to the patient or the 9 patient’s discharge. 10 Sec. 5. NEW SECTION . 144F.5 Hospital discharge process —— 11 evidence-based practices. 12 A hospital’s discharge process may incorporate established 13 evidence-based practices, including but not limited to any of 14 the following: 15 1. The standards for accreditation adopted by the joint 16 commission on the accreditation of health care organizations 17 or any other nationally recognized hospital accreditation 18 organization. 19 2. The conditions of participation for hospitals adopted by 20 the centers for Medicare and Medicaid services of the United 21 States department of health and human services. 22 Sec. 6. NEW SECTION . 144F.6 Construction of chapter 23 relative to other health care directives. 24 Nothing in this chapter shall be construed to interfere with 25 the authority or responsibilities of an agent operating under 26 a valid durable power of attorney for health care pursuant to 27 chapter 144B or of the powers and duties granted to a guardian 28 pursuant to section 633.635. 29 Sec. 7. NEW SECTION . 144F.7 Limitations. 30 1. Nothing in this chapter shall be construed to create 31 a private right of action against a hospital, a hospital 32 employee, or any consultant or contractor with whom a hospital 33 has a contractual relationship, or to limit or otherwise 34 supersede or replace existing rights or remedies under any 35 -4- HF2434.4452 (5) 87 pf/rh 4/ 5

other provision of law. 1 2. Nothing in this chapter shall delay the appropriate 2 discharge or transfer of a patient. 3 3. Nothing in this chapter shall be construed to interfere 4 with or supersede a health care provider’s instructions 5 regarding a Medicare-certified home health agency or any other 6 post-acute care provider. 7 4. Nothing in this chapter shall be construed to grant 8 decision-making authority to a lay caregiver to determine the 9 type of provider or provider of the patient’s post-hospital 10 care as specified in the patient’s discharge plan. > 11 ______________________________ DOLECHECK of Ringgold -5- HF2434.4452 (5) 87 pf/rh 5/ 5