S.F. _____ Section 1. FINDINGS AND INTENT. The general assembly finds 1 and declares that: 2 1. According to AARP Iowa, at any given time, an estimated 3 540,000 Iowans provide varying degrees of unreimbursed 4 care to adults with limitations in daily activities at some 5 point during a year. The total value of such unpaid care to 6 individuals in need of long-term services and supports amounts 7 to an estimated $4.1 billion, annually. 8 2. Caregivers are often members of the individual’s 9 immediate family, but friends and other community members also 10 serve as caregivers. Although most caregivers are asked to 11 assist an individual with basic activities of daily living, 12 such as mobility, eating, and dressing, many are expected to 13 perform complex tasks on a daily basis, such as administering 14 multiple medications, providing wound care, and operating 15 medical equipment. 16 3. Despite the vast importance of caregivers in the 17 individual’s day-to-day care, many caregivers find they are 18 often left out of discussions involving a patient’s care while 19 in the hospital and, upon the patient’s discharge, receive 20 little instruction on the tasks they are expected to perform. 21 4. The centers for Medicare and Medicaid Services of the 22 United States department of health and human services estimates 23 that $17 billion in Medicare funds is spent each year on 24 unnecessary hospital readmissions. Additionally, hospitals 25 desire to avoid the imposition of new readmission penalties 26 under the federal Patient Protection and Affordable Care Act, 27 Pub. L. No. 111-148, as amended by the federal Health Care and 28 Education Reconciliation Act of 2010, Pub. L. No. 111-152. 29 5. In order to successfully address the challenges of a 30 surging population of older adults and others living with 31 chronic conditions and who have significant needs for long-term 32 services and supports, the state must develop methods to enable 33 caregivers to continue to support their loved ones at home and 34 in the community, and avoid costly hospital readmissions. 35 -1- LSB 2129XC (2) 86 pf/nh 1/ 8

S.F. _____ 6. It is the intent of the general assembly that this Act 1 enables caregivers to provide competent post-hospital care to 2 their family members and other loved ones, at minimal cost to 3 the taxpayers of Iowa. 4 Sec. 2. NEW SECTION . 144E.1 Definitions. 5 As used in this chapter, unless the context otherwise 6 requires: 7 1. “After-care assistance” means any assistance provided 8 by a caregiver to a patient following the patient’s discharge 9 from a hospital that is related to the patient’s condition 10 at the time of discharge, including but not limited to 11 assisting with basic activities of daily living, assisting 12 with instrumental activities of daily living, and performing 13 other tasks including but not limited to managing wound care, 14 assisting in the administering of medications, and operating 15 medical equipment, as determined to be appropriate by the 16 patient’s discharging physician or other licensed health care 17 professional. 18 2. “Caregiver” means any individual designated as a 19 caregiver by a patient who provides after-care assistance to a 20 patient in the patient’s residence. “Caregiver” includes but is 21 not limited to a relative, spouse, partner, friend, or neighbor 22 who has a significant relationship with the patient. 23 3. “Discharge” means a patient’s exit or release from a 24 hospital to the patient’s residence following an inpatient 25 admission. 26 4. “Entry” means a patient’s admission into a hospital for 27 the purposes of receiving inpatient medical care. 28 5. “Facility” means a health care facility as defined in 29 section 135C.1, an elder group home as defined in section 30 231B.1, or an assisted living program as defined in section 31 231C.2. 32 6. “Hospital” means a licensed hospital as defined in 33 section 135B.1. 34 7. “Residence” means the dwelling that the patient considers 35 -2- LSB 2129XC (2) 86 pf/nh 2/ 8

S.F. _____ to be the patient’s home. “Residence” does not include any 1 rehabilitation facility, hospital, nursing home, assisted 2 living facility, or group home licensed by the department of 3 inspections and appeals. 4 Sec. 3. NEW SECTION . 144E.2 Caregiver —— opportunity to 5 designate. 6 1. a. A hospital shall provide each patient or, if 7 applicable, the patient’s legal guardian with an opportunity 8 to designate at least one caregiver within twenty-four hours 9 following the patient’s entry into a hospital, and prior to 10 the patient’s discharge or transfer to another hospital or 11 facility. 12 b. If the patient is unconscious or otherwise incapacitated 13 upon entry into the hospital, the hospital shall provide the 14 patient or the patient’s legal guardian with an opportunity to 15 designate a caregiver within twenty-four hours following the 16 patient’s recovery of consciousness or capacity. 17 c. If the patient or legal guardian declines to designate 18 a caregiver, the hospital shall promptly document this 19 declination in the patient’s medical record. 20 d. If the patient or the patient’s legal guardian designates 21 an individual as a caregiver, all of the following shall apply: 22 (1) The hospital shall promptly request the written consent 23 of the patient or the patient’s legal guardian to release 24 medical information to the patient’s caregiver following the 25 hospital’s established procedures for releasing personal health 26 information and in compliance with all federal and state 27 laws. If the patient or the patient’s legal guardian declines 28 to consent to release medical information to the patient’s 29 caregiver, the hospital shall not be required to provide notice 30 to the caregiver under section 144E.3 or to provide information 31 contained in the patient’s discharge plan to the caregiver 32 under section 144E.4. 33 (2) The hospital shall record the patient’s designation of 34 caregiver, the relationship of the caregiver to the patient, 35 -3- LSB 2129XC (2) 86 pf/nh 3/ 8

S.F. _____ and the name, telephone number, and address of the patient’s 1 caregiver in the patient’s medical record. 2 e. A patient or the patient’s legal guardian may elect to 3 change the designation of the patient’s caregiver at any time, 4 and the hospital shall record such change in the patient’s 5 medical record within twenty-four hours and prior to the 6 patient’s discharge. 7 2. The designation of a caregiver by a patient or a 8 patient’s legal guardian does not obligate the designated 9 individual to perform any after-care assistance for the 10 patient. 11 3. This section shall not be construed to require a patient 12 or a patient’s legal guardian to designate any individual as a 13 caregiver. 14 Sec. 4. NEW SECTION . 144E.3 Notification of caregiver. 15 A hospital shall notify the patient’s caregiver of the 16 patient’s discharge or transfer to another hospital or facility 17 as soon as possible upon issuance of a discharge or transfer 18 order by the patient’s attending physician, but no later than 19 four hours prior to the patient’s actual discharge or transfer 20 to another hospital or facility. If the hospital is unable to 21 contact the caregiver, the lack of contact shall not interfere 22 with, delay, or otherwise affect the medical care provided to 23 the patient, or an appropriate discharge or transfer of the 24 patient. 25 Sec. 5. NEW SECTION . 144E.4 Instructions to caregiver. 26 1. As soon as possible and no later than twenty-four hours 27 prior to a patient’s discharge from a hospital, the hospital 28 shall consult with the caregiver along with the patient 29 regarding the caregiver’s capabilities and limitations and 30 issue a discharge plan that describes the patient’s after-care 31 assistance needs at the patient’s residence. At a minimum, the 32 discharge plan shall include: 33 a. The name and contact information of the caregiver. 34 b. A description of all after-care assistance tasks 35 -4- LSB 2129XC (2) 86 pf/nh 4/ 8

S.F. _____ necessary to maintain the patient’s ability to reside at the 1 patient’s residence. 2 c. Contact information for any health care, community 3 resource, and long-term services and supports necessary to 4 successfully carry out the patient’s discharge plan. 5 2. The hospital issuing the discharge plan shall provide 6 a caregiver with instructions for all after-care assistance 7 tasks described in the discharge plan. At a minimum, this 8 instruction shall include: 9 a. A live demonstration of the tasks performed by an 10 individual designated by the hospital who is authorized 11 to perform the after-care assistance task, provided in 12 a culturally-competent manner and in accordance with the 13 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. 6. NEW SECTION . 144E.5 Adoption of rules. 22 The department of public health, in consultation with the 23 department of inspections and appeals, 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. 7. NEW SECTION . 144E.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. 8. NEW SECTION . 144E.7 Limitations. 33 Nothing in this chapter shall be construed to create 34 a private right of action against a hospital, a hospital 35 -5- LSB 2129XC (2) 86 pf/nh 5/ 8

S.F. _____ employee, or any consultant or contractor with whom a hospital 1 has a contractual relationship, or to otherwise supersede or 2 replace existing rights or remedies under any other provision 3 of law. 4 EXPLANATION 5 The inclusion of this explanation does not constitute agreement with 6 the explanation’s substance by the members of the general assembly. 7 This bill relates to the designation of a caregiver relative 8 to an inpatient admission of a patient to a hospital to provide 9 after-care assistance to the patient upon discharge of the 10 patient to the patient’s residence. The bill provides the 11 findings and intent of the general assembly and definitions 12 used in the new Code chapter 144E, including “after-care 13 assistance”, “caregiver”, “discharge”, “entry”, “facility”, 14 “hospital”, and “residence”. 15 The bill requires a hospital to provide each patient or, if 16 applicable, the patient’s legal guardian, with an opportunity 17 to designate at least one caregiver within 24 hours following 18 the patient’s entry into a hospital, and prior to the patient’s 19 discharge or transfer to another hospital or facility, and 20 provides for situations in which the patient is unconscious or 21 otherwise incapacitated or if the patient or patient’s legal 22 guardian declines to designate a caregiver. If a patient or 23 patient’s legal guardian designates a caregiver, the hospital 24 is required to promptly request the written consent of the 25 patient or the patient’s legal guardian to release medical 26 information to the patient’s caregiver following the hospital’s 27 established procedures and in compliance with all federal and 28 state laws. If the patient or the patient’s legal guardian 29 declines to consent to release medical information to the 30 patient’s caregiver, the hospital is not required to provide 31 notification to the caregiver or to provide information 32 contained in the patient’s discharge plan to the caregiver. 33 The hospital is required to record the patient’s designation of 34 caregiver, the relationship of the caregiver to the patient, 35 -6- LSB 2129XC (2) 86 pf/nh 6/ 8

S.F. _____ and the name, telephone number, and address of the patient’s 1 caregiver in the patient’s medical record. The bill allows 2 for a change in the caregiver designation by a patient or the 3 patient’s legal guardian at any time. The bill provides that 4 the designation of a caregiver by a patient or a patient’s 5 legal guardian does not obligate the designated individual to 6 perform any after-care assistance for the patient and that 7 the provisions of the bill are not to be construed to require 8 a patient or a patient’s legal guardian to designate any 9 individual as a caregiver. 10 Under the bill, a hospital is required to notify the 11 patient’s caregiver of the patient’s discharge or transfer to 12 another hospital or facility as soon as possible upon issuance 13 of a discharge or transfer order by the patient’s attending 14 physician, but no later than four hours prior to the patient’s 15 actual discharge or transfer to another hospital or facility. 16 If the hospital is unable to contact the caregiver, the lack of 17 contact shall not interfere with, delay, or otherwise affect 18 the medical care provided to the patient, or an appropriate 19 discharge of the patient. 20 Under the bill, as soon as possible and no later than 24 21 hours prior to a patient’s discharge from a hospital, the 22 hospital is required to consult with the caregiver along 23 with the patient regarding the caregiver’s capabilities 24 and limitations and issue a discharge plan that describes 25 the patient’s after-care assistance needs at the patient’s 26 residence. The bill also requires specified minimum 27 instructions to be provided to the caregiver. 28 The bill directs the department of public health to adopt 29 rules, in cooperation with the department of inspections 30 and appeals, to administer the bill. The bill is not to be 31 construed to interfere with the rights of an agent operating 32 under a valid durable power of attorney for health care, and 33 is not to be construed to create a private right of action 34 against a hospital, a hospital employee, or any consultant or 35 -7- LSB 2129XC (2) 86 pf/nh 7/ 8