Senate File 2423 S-5048 Amend Senate File 2423 as follows: 1 1. By striking everything after the enacting clause and 2 inserting: 3 < Section 1. NEW SECTION . 144H.1 Definitions. 4 For purposes of this chapter, unless the context otherwise 5 requires: 6 1. “Able to consent” means a patient is willing and able 7 to communicate a decision independently or with appropriate 8 services, technological assistance, support decision making, or 9 other reasonable accommodation and is able to understand the 10 nature and consequences of the decision, including the primary 11 risks and benefits of a decision. 12 2. “Authorized representative” means any of the following: 13 a. An agent as that term is defined in section 633B.102. 14 b. An attorney in fact as that term is defined in section 15 144B.1. 16 c. A conservator as that term is defined in section 17 633B.102. 18 d. A guardian as that term is defined in section 633B.102. 19 e. A public guardian as that term is defined in chapter 20 231E. 21 3. “Care facility” means a facility that provides a patient 22 with health-related and personal care services, including any 23 of the following: 24 a. A hospital. 25 b. A medical clinic. 26 c. A nursing facility. 27 d. A rehabilitation facility as that term is defined in 28 section 135C.1. 29 e. A residential care facility as that term is defined in 30 section 135C.1. 31 4. “Department” means the department of health and human 32 services. 33 5. “Patient” means an adult who is receiving health-related 34 or personal care services from a care facility. 35 -1- SF 2423.3018 (2) 91 (amending this SF 2423 to CONFORM to HF 2562) ak/ko 1/ 8 #1.

6. “Person authorized to consent” means a member of any of 1 the following groups of individuals, in order of priority, who 2 is willing and able to consent, refuse to consent, or withdraw 3 consent on a patient’s behalf: 4 a. The patient’s spouse. 5 b. An adult child of the patient or, if the patient has more 6 than one adult child, the decision agreed to by half or more of 7 the adult children reasonably available for consultation with 8 the patient’s physician. 9 c. A parent or parents of a patient, if one or both parents 10 are reasonably available for consultation with the patient’s 11 physician. 12 d. An adult sibling of the patient or, if the patient has 13 more than one adult sibling, the decision agreed to by half or 14 more of the adult siblings who are reasonably available for 15 consultation with the patient’s physician. 16 7. “Placement” means the admission, discharge, or transfer 17 of a patient. 18 8. “Public assistance program” means a state or federally 19 funded program including but not limited to: 20 a. The Medicaid program as that term is defined in section 21 249A.2. 22 b. Medicare pursuant to the federal government health 23 insurance program established under Tit. XVIII of the Social 24 Security Act. 25 c. A medical benefits package pursuant to 38 C.F.R. §17.38. 26 Sec. 2. NEW SECTION . 144H.2 Inability to consent —— 27 certification. 28 Upon examination of a patient, a physician licensed under 29 chapter 148 may certify in the patient’s medical records 30 that in the professional opinion of the physician all of the 31 following are true: 32 1. The patient is not able to consent. 33 2. Despite good-faith efforts, an authorized representative 34 for the patient has not been located by the physician. 35 -2- SF 2423.3018 (2) 91 (amending this SF 2423 to CONFORM to HF 2562) ak/ko 2/ 8

3. It is in the patient’s best interests to be discharged 1 from the patient’s current care facility and to be transferred 2 or admitted to a care facility recommended by the physician. 3 Sec. 3. NEW SECTION . 144H.3 Person authorized to consent —— 4 powers and duties. 5 1. Upon a physician’s certification pursuant to section 6 144H.2, a person authorized to consent is authorized to do any 7 of the following: 8 a. Make decisions regarding the patient’s care facility 9 placement. 10 b. Assist the patient in applying for health insurance 11 coverage through a private insurer, or applying for a public 12 assistance program, as necessary to facilitate the patient’s 13 care facility placement. 14 c. Take any other action expressly authorized by the 15 patient. 16 2. A person authorized to consent shall act in good faith 17 and must consider all of the following: 18 a. The patient’s wishes, if known. 19 b. The patient’s rights. 20 c. The best interests of the patient. 21 3. A person authorized to consent may, as reasonably 22 necessary to assist the patient in applying for health 23 insurance coverage through a private insurer, or applying for a 24 public assistance program, do any of the following: 25 a. Access the patient’s banking and other financial records 26 as permitted by state and federal law. This paragraph shall 27 not be construed to permit the person authorized to consent to 28 own, manage, use, or dispose of any of the patient’s financial 29 resources without the patient’s express consent. 30 b. Disclose the patient’s relevant health information to 31 a third party. The person authorized to consent shall not 32 disclose a patient’s protected health information in violation 33 of the federal Health Insurance Portability and Accountability 34 Act of 1996, Pub. L. No. 104-191. 35 -3- SF 2423.3018 (2) 91 (amending this SF 2423 to CONFORM to HF 2562) ak/ko 3/ 8

4. The authority of a person authorized to consent shall 1 expire upon the earliest of any of the following: 2 a. The date that the patient’s care facility placement 3 as decided by the person authorized to consent is completed, 4 and notice of approval or denial of an application for health 5 insurance coverage through a private insurer, or for a public 6 assistance program, if applicable, is received by a qualified 7 employee of the receiving care facility. 8 b. An authorized representative, or a person authorized to 9 consent who has higher priority, has been located. 10 Sec. 4. NEW SECTION . 144H.4 Care facility —— duties. 11 1. A social worker, discharge planner, or other qualified 12 employee as designated by a patient’s current care facility 13 shall do all of the following with respect to a person 14 authorized to consent: 15 a. Inform the person of the person’s powers and duties 16 pursuant to this chapter. 17 b. Assist the person with identifying a receiving care 18 facility for the patient that can provide the appropriate 19 level of care, as recommended by the physician under section 20 144H.2, to the patient in the least restrictive environment and 21 consented to by a social worker, intake coordinator, or other 22 qualified employee of the receiving care facility. 23 2. If a receiving care facility as described in subsection 24 1 is identified, and the receiving care facility consents to 25 the transfer, the patient shall be transferred to the receiving 26 care facility. 27 Sec. 5. NEW SECTION . 144H.5 Petition for court order. 28 1. After good-faith efforts to locate an authorized 29 representative for the patient or a person authorized to 30 consent, a care facility or attending physician may petition a 31 court of competent jurisdiction to order any of the following: 32 a. The patient’s care facility placement. 33 b. The patient’s attending physician or a social worker, 34 intake worker, or other qualified employee of the receiving 35 -4- SF 2423.3018 (2) 91 (amending this SF 2423 to CONFORM to HF 2562) ak/ko 4/ 8

care facility to assist the patient to apply for health 1 insurance coverage through a private insurer or apply for a 2 public assistance program, if appropriate. 3 2. The petition made must include the following 4 information: 5 a. The name, age, and address where the patient resides, if 6 known to the petitioner. 7 b. The name, address, and county of residence of the 8 petitioner. 9 c. The relationship of the petitioner to the patient. 10 d. The address where the patient can be found, if different 11 from the patient’s residential address. 12 e. A physician’s certification pursuant to section 144H.2. 13 f. An affidavit from the patient’s attending physician, 14 that upon an examination of the patient and consultation with 15 another health care provider, all of the following are true: 16 (1) The patient is not able to consent. 17 (2) The patient has not identified, and despite good-faith 18 efforts the attending physician has been unable to locate, an 19 authorized representative or a person authorized to consent. 20 (3) The receiving care facility placement recommended by 21 the attending physician is in the patient’s best interests. 22 (4) The receiving care facility placement recommended by 23 the attending physician will provide the most appropriate level 24 of care to the patient in the least restrictive environment, 25 and is within a reasonable proximity to the patient’s 26 residence, if applicable. 27 g. An affidavit from a social worker, discharge planner, or 28 other qualified employee as designated by the patient’s current 29 care facility attesting to all of the following: 30 (1) The patient has not identified, and despite good-faith 31 efforts the current care facility has been unable to locate, an 32 authorized representative or a person authorized to consent. 33 (2) The receiving care facility placement recommended 34 by the patient’s attending physician will provide the 35 -5- SF 2423.3018 (2) 91 (amending this SF 2423 to CONFORM to HF 2562) ak/ko 5/ 8

most appropriate level of care to the patient in the least 1 restrictive environment. 2 (3) Other care facilities within a reasonable proximity 3 to the patient’s residence were considered for placement, if 4 applicable. 5 h. An affidavit from a social worker, intake coordinator, 6 or other qualified employee of the receiving care facility 7 recommended by the patient’s attending physician attesting to 8 all of the following: 9 (1) The receiving care facility is an appropriate facility 10 available for the patient. 11 (2) The receiving care facility can provide the most 12 appropriate level of care to the patient in the least 13 restrictive environment. 14 (3) The receiving care facility consents to the transfer or 15 admission of the patient. 16 i. The name and address of the receiving care facility 17 recommended by the attending physician. 18 3. The court may grant the petition if the court finds all 19 of the following: 20 a. The patient is not able to consent. 21 b. Despite good-faith efforts by the attending physician 22 and the patient’s current care facility, an authorized 23 representative or person authorized to consent has not been 24 located. 25 c. Placement in the receiving care facility recommended 26 by the patient’s attending physician is in the patient’s best 27 interest. 28 d. Placement in the receiving care facility recommended 29 by the patient’s attending physician will provide the 30 most appropriate level of care to the patient in the least 31 restrictive environment. 32 e. A social worker, intake coordinator, or other qualified 33 employee of the receiving care facility recommended by the 34 patient’s attending physician has consented to the admission 35 -6- SF 2423.3018 (2) 91 (amending this SF 2423 to CONFORM to HF 2562) ak/ko 6/ 8

of the patient. 1 4. If the court grants the petition under subsection 3, the 2 court shall also order, if necessary, that a qualified employee 3 of the receiving care facility has the authority to apply for a 4 public assistance program on the patient’s behalf. 5 5. An order authorizing placement pursuant to this section 6 shall remain in effect until the earliest of any of the 7 following: 8 a. A date specified by the court not to exceed thirty 9 calendar days from the date of issuance of the order. 10 b. The date the patient’s placement in the receiving care 11 facility as ordered by the court is completed. 12 c. The date an attending physician certifies that the 13 patient is able to consent to the patient’s placement in the 14 receiving care facility. 15 6. An order authorizing a qualified employee of a receiving 16 facility to apply for a public assistance program on a 17 patient’s behalf pursuant to this section shall remain in 18 effect until the earliest of any of the following: 19 a. A date specified by the court. 20 b. Notice of approval or denial of an application for health 21 insurance coverage through a private insurer, or for a public 22 assistance program is received by a qualified employee of the 23 receiving facility. 24 c. The date that an attending physician certifies that the 25 patient is able to consent to the application for a public 26 assistance program. 27 Sec. 6. NEW SECTION . 144H.6 Immunity —— liability and 28 professional discipline. 29 1. A person or care facility acting in good faith pursuant 30 to this chapter shall not be subject to civil or criminal 31 liability. 32 2. A licensee under chapter 148 acting reasonably and in 33 good faith pursuant to this chapter shall not be subject to 34 licensee discipline. 35 -7- SF 2423.3018 (2) 91 (amending this SF 2423 to CONFORM to HF 2562) ak/ko 7/ 8

Sec. 7. NEW SECTION . 144H.7 Construction. 1 This chapter shall not be construed to do any of the 2 following: 3 1. Require a care facility to accept the transfer or 4 admission of a patient. 5 2. Repeal, abrogate, or impair the operation of any other 6 federal or state laws governing the transfer, admission, or 7 discharge of a patient to or from a care facility. 8 3. Infringe upon the rights of a patient under federal or 9 state law relating to the involuntary transfer, admission, or 10 discharge to or from a care facility. 11 Sec. 8. NEW SECTION . 144H.8 Rules. 12 The department may promulgate rules pursuant to chapter 17A 13 as necessary to administer this chapter. > 14 ______________________________ MARK COSTELLO -8- SF 2423.3018 (2) 91 (amending this SF 2423 to CONFORM to HF 2562) ak/ko 8/ 8