H.F. _____ Section 1. NEW SECTION . 144H.1 Definitions. 1 For purposes of this chapter, unless the context otherwise 2 requires: 3 1. “Authorized representative” means any of the following: 4 a. An agent as that term is defined in section 633B.102. 5 b. An attorney in fact as that term is defined in section 6 144B.1. 7 c. A conservator as that term is defined in section 8 633B.102. 9 d. A guardian as that term is defined in section 633B.102. 10 e. A public guardian as that term is defined in chapter 11 231E. 12 2. “Care facility” means a facility that provides a patient 13 with health-related and personal care services, including any 14 of the following: 15 a. A facility providing home and community-based services. 16 b. A hospital. 17 c. A medical clinic. 18 d. A nursing facility. 19 e. A rehabilitation facility as that term is defined in 20 section 135C.1. 21 f. A residential care facility as that term is defined in 22 section 135C.1. 23 3. “Department” means the department of health and human 24 services. 25 4. “Patient” means an adult who is receiving health-related 26 or personal care services from a care facility. 27 5. “Person authorized to consent” means a member of any of 28 the following groups of individuals, in order of priority, who 29 is willing and able to consent, refuse to consent, or withdraw 30 consent on a patient’s behalf: 31 a. The patient’s spouse. 32 b. An adult child or stepchild of the patient, or, if 33 the patient has more than one adult child or stepchild, the 34 decision agreed to by a majority of the adult children and 35 -1- LSB 5341YC (8) 91 ak/ko 1/ 10

H.F. _____ stepchildren reasonably available for consultation with the 1 patient’s physician. 2 c. A parent or parents of a patient, if one or both parents 3 are reasonably available for consultation with the patient’s 4 physician. 5 d. An adult sibling or stepsibling of the patient or, if 6 the patient has more than one adult sibling or stepsibling, 7 the decision agreed to by a majority of the adult siblings and 8 stepsiblings who are reasonably available for consultation with 9 the patient’s physician. 10 6. “Placement” means the admission, discharge, or transfer 11 of a patient. 12 7. “Public assistance program” means a state or federally 13 funded program including but not limited to: 14 a. The Medicaid program as that term is defined in section 15 249A.2. 16 b. Medicare pursuant to the federal government health 17 insurance program established under Tit. XVIII of the Social 18 Security Act. 19 c. A medical benefits package pursuant to 38 C.F.R. §17.38. 20 8. “Unable to consent” means a patient is unable to do any 21 of the following: 22 a. Make rational and competent decisions regarding care 23 facility placement, and options for health insurance coverage 24 for recommended care. 25 b. Communicate, by any means, decisions regarding care 26 facility placement, and options for health insurance coverage 27 for recommended care. 28 Sec. 2. NEW SECTION . 144H.2 Inability to consent —— 29 certification. 30 Upon examination of a patient, a physician licensed under 31 chapter 148 may certify in the patient’s medical records 32 that in the professional opinion of the physician all of the 33 following are true: 34 1. The patient is unable to consent. 35 -2- LSB 5341YC (8) 91 ak/ko 2/ 10

H.F. _____ 2. Despite good-faith efforts, an authorized representative 1 for the patient has not been located by the physician. 2 3. It is in the patient’s best interests to be discharged 3 from the patient’s current care facility and to be transferred 4 or admitted to a care facility recommended by the physician. 5 Sec. 3. NEW SECTION . 144H.3 Person authorized to consent —— 6 powers and duties. 7 1. Upon a physician’s certification pursuant to section 8 144H.2, a person authorized to consent is authorized to do any 9 of the following: 10 a. Make decisions regarding the patient’s care facility 11 placement. 12 b. Assist the patient in applying for health insurance 13 coverage through a private insurer, or applying for a public 14 assistance program, as necessary to facilitate the patient’s 15 care facility placement. 16 c. Take any other action expressly authorized by the 17 patient. 18 2. A person authorized to consent shall act in good faith 19 and must consider all of the following: 20 a. The best interests of the patient. 21 b. The patient’s rights. 22 c. The patient’s wishes, if known. 23 3. The authority of a person authorized to consent shall 24 expire upon the earliest of any of the following: 25 a. The date that the patient’s care facility placement 26 as decided by the person authorized to consent is completed, 27 and notice of approval or denial of an application for health 28 insurance coverage through a private insurer, or for a public 29 assistance program, if applicable, is received by a qualified 30 employee of the receiving care facility. 31 b. An authorized representative, or a person authorized to 32 consent who has higher priority, has been located. 33 Sec. 4. NEW SECTION . 144H.4 Care facility —— duties. 34 A social worker, discharge planner, or other qualified 35 -3- LSB 5341YC (8) 91 ak/ko 3/ 10

H.F. _____ employee as designated by a patient’s current care facility 1 shall do all of the following with respect to a person 2 authorized to consent: 3 1. Inform the person of the person’s powers and duties 4 pursuant to this chapter. 5 2. Assist the person with identifying a receiving care 6 facility for the patient that can provide the least restrictive 7 and appropriate level of care, as recommended by the physician 8 under section 144H.2, for the patient and consented to by a 9 social worker, intake coordinator, or other qualified employee 10 of the receiving care facility. 11 Sec. 5. NEW SECTION . 144H.5 Petition for court order. 12 1. After good-faith efforts to locate an authorized 13 representative for the patient or a person authorized to 14 consent, a care facility or attending physician may petition 15 a court of competent jurisdiction to order the patient’s care 16 facility placement. 17 2. The petition made must include the following 18 information: 19 a. The name, age, and address where the patient resides, if 20 known to the petitioner. 21 b. The name, address, and county of residence of the 22 petitioner. 23 c. The relationship of the petitioner to the patient. 24 d. The address where the patient can be found, if different 25 from the patient’s residential address. 26 e. A physician’s certification pursuant to section 144H.2. 27 f. An affidavit from the patient’s attending physician, that 28 upon an examination of the patient, all of the following are 29 true: 30 (1) The patient is unable to consent. 31 (2) The patient has not identified, and despite good-faith 32 efforts the attending physician has been unable to locate, an 33 authorized representative or a person authorized to consent. 34 (3) The receiving care facility placement recommended by 35 -4- LSB 5341YC (8) 91 ak/ko 4/ 10

H.F. _____ the attending physician is in the patient’s best interests. 1 (4) The receiving care facility placement recommended by 2 the attending physician will provide the least restrictive and 3 most appropriate level of care for the patient, and is within a 4 reasonable proximity to the patient’s residence, if applicable. 5 g. An affidavit from a social worker, discharge planner, or 6 other qualified employee as designated by the patient’s current 7 care facility attesting to all of the following: 8 (1) The patient has not identified, and despite good-faith 9 efforts the current care facility has been unable to locate, an 10 authorized representative or a person authorized to consent. 11 (2) The receiving care facility placement recommended by 12 the attending physician will provide the least restrictive and 13 most appropriate level of care for the patient. 14 (3) Other care facilities within a reasonable proximity 15 to the patient’s residence were considered for placement, if 16 applicable. 17 h. An affidavit from a social worker, intake coordinator, 18 or other qualified employee of the receiving care facility 19 recommended by the patient’s attending physician attesting to 20 all of the following: 21 (1) The receiving care facility is the most appropriate 22 facility available for the patient. 23 (2) The receiving care facility can provide the least 24 restrictive and most appropriate level of care to the patient. 25 (3) The receiving care facility consents to the transfer or 26 admission of the patient. 27 i. The name and address of the receiving care facility 28 recommended by the attending physician. 29 3. The court shall grant the petition if the court finds all 30 of the following: 31 a. The patient is unable to consent. 32 b. Despite good-faith efforts by the attending physician 33 and the patient’s current care facility, an authorized 34 representative or person authorized to consent has not been 35 -5- LSB 5341YC (8) 91 ak/ko 5/ 10

H.F. _____ located. 1 c. Placement in the receiving care facility recommended 2 by the patient’s attending physician is in the patient’s best 3 interest. 4 d. Placement in the receiving care facility recommended 5 by the patient’s attending physician will provide the least 6 restrictive and most appropriate level of care for the patient. 7 e. A social worker, intake coordinator, or other qualified 8 employee of the receiving care facility recommended by the 9 patient’s attending physician has consented to the admission 10 of the patient. 11 4. If the court grants the petition under subsection 3, the 12 court shall also order, if necessary, that a qualified employee 13 of the receiving care facility has the authority to apply for a 14 public assistance program on the patient’s behalf. 15 5. An order authorizing placement pursuant to this section 16 shall remain in effect until the earliest of any of the 17 following: 18 a. A date specified by the court not to exceed thirty 19 calendar days from the date of issuance of the order. 20 b. The date the patient’s placement in the receiving care 21 facility as ordered by the court is completed. 22 c. The date an attending physician certifies that the 23 patient is able to consent to the patient’s placement in the 24 receiving care facility. 25 6. An order authorizing a qualified employee of a receiving 26 facility to apply for a public assistance program on a 27 patient’s behalf pursuant to this section shall remain in 28 effect until the earliest of any of the following: 29 a. A date specified by the court. 30 b. Notice of approval or denial of an application for health 31 insurance coverage through a private insurer, or for a public 32 assistance program is received by a qualified employee of the 33 receiving facility. 34 c. The date that an attending physician certifies that the 35 -6- LSB 5341YC (8) 91 ak/ko 6/ 10

H.F. _____ patient is able to consent to the application for a public 1 assistance program. 2 Sec. 6. NEW SECTION . 144H.6 Immunity —— liability and 3 professional discipline. 4 1. A person acting in good faith pursuant to this chapter 5 shall not be subject to civil or criminal liability. 6 2. A licensee under chapter 148 acting in good faith 7 pursuant to this chapter shall not be subject to licensee 8 discipline. 9 Sec. 7. NEW SECTION . 144H.7 Construction. 10 This chapter shall not be construed to do any of the 11 following: 12 1. Require a care facility to accept the transfer or 13 admission of a patient, unless otherwise ordered by a court of 14 competent jurisdiction. 15 2. Repeal, abrogate, or impair the operation of any other 16 federal or state laws governing the transfer, admission, or 17 discharge of a patient to or from a care facility. 18 3. Infringe upon the rights of a patient under federal or 19 state law relating to the involuntary transfer, admission, or 20 discharge to or from a care facility. 21 Sec. 8. NEW SECTION . 144H.8 Rules. 22 The department shall promulgate rules pursuant to chapter 23 17A as necessary to administer this chapter. 24 EXPLANATION 25 The inclusion of this explanation does not constitute agreement with 26 the explanation’s substance by the members of the general assembly. 27 This bill relates to care facility placement decisions for 28 certain adults. 29 The bill defines “authorized representative” as an agent, 30 attorney in fact, conservator, or guardian. “Person authorized 31 to consent” (authorized person) is defined as a member of 32 any of the following groups of individuals, in order of 33 priority, that is willing and able to consent, refuse to 34 consent, or withdraw consent on a patient’s behalf: the 35 -7- LSB 5341YC (8) 91 ak/ko 7/ 10

H.F. _____ patient’s spouse, the adult children or stepchildren, the 1 parent or parents of a patient, or the adult siblings or 2 stepsiblings of the patient. “Care facility” is defined 3 as a facility that provides a patient with health-related 4 and personal care services, including a facility providing 5 home and community-based services, hospital, medical clinic, 6 nursing facility, rehabilitation facility, or residential care 7 facility. “Placement” is defined as the admission, discharge, 8 or transfer of a patient. 9 The bill provides that a physician licensed under the laws 10 of this state may certify in a patient’s record that the 11 patient is unable to consent, an authorized representative 12 for the patient has not been located by the physician despite 13 good-faith efforts, and that it is in the patient’s best 14 interests to be discharged from the patient’s current care 15 facility and transferred or admitted to a care facility 16 recommended by the physician. “Patient” and “unable to 17 consent” are defined in the bill. 18 The bill provides that an authorized person shall act in 19 good faith and in the best interests of the patient, consistent 20 with the patient’s rights and wishes. The bill authorizes 21 the authorized person, upon the physician’s certification, to 22 make care facility placement decisions and assist the patient 23 in applying for health insurance coverage through private 24 insurance, or for a public assistance program, as necessary to 25 facilitate placement. 26 The bill provides that the authority of an authorized person 27 expires when the placement decided by the authorized person is 28 completed and notice of approval or denial of an application 29 for health insurance coverage through a private insurer, or 30 for a public assistance program, if applicable, is received by 31 a qualified employee of the receiving care facility, or when 32 an authorized representative or authorized person of higher 33 priority is located. 34 The bill requires a social worker, discharge planner, or 35 -8- LSB 5341YC (8) 91 ak/ko 8/ 10

H.F. _____ other qualified employee as designated by the current care 1 facility of the patient to inform an authorized person of 2 the person’s powers and duties and to assist the person with 3 identifying a receiving care facility for the patient that will 4 provide the least restrictive and appropriate level of care for 5 the patient as recommended by the certifying physician. 6 After a good-faith effort to locate an authorized 7 representative or authorized person, the bill allows an 8 attending physician or a care facility to petition a court 9 of competent jurisdiction to order placement. The petition 10 must include certain information about the patient, the 11 petitioner, the current care facility, and the proposed 12 receiving care facility, and be supported by affidavits from 13 an attending physician, a social worker, discharge planner, 14 or other qualified employee from both the current and the 15 proposed receiving care facility. The bill requires the 16 court to grant the petition if it finds that the patient 17 is unable to consent, no authorized representative for the 18 patient or authorized person has been located by the attending 19 physician and the patient’s current care facility despite 20 good-faith efforts, placement in the receiving care facility 21 recommended to the court by the patient’s attending physician 22 is in the best interests of the patient, and will provide 23 the least restrictive and most appropriate level of care for 24 the patient. A social worker, intake coordinator, or other 25 qualified employee of the proposed receiving care facility must 26 consent to the admission of the patient. If a court order 27 authorizes a patient’s transfer to the receiving care facility, 28 the authority, if necessary, to apply for a public assistance 29 program on the patient’s behalf shall transfer pursuant to 30 court order to a qualified employee of the receiving care 31 facility. 32 The bill provides that the court’s order shall be effective 33 until a date specified by the court not to exceed 30 calendar 34 days from the date of the issuance of the order, the completion 35 -9- LSB 5341YC (8) 91 ak/ko 9/ 10

H.F. _____ of any placement of the patient in the receiving care facility 1 as ordered, or the date that a physician certifies that the 2 patient is able to consent to the patient’s placement in a care 3 facility. 4 The bill provides that a court order authorizing a qualified 5 employee of a receiving facility to apply for a public 6 assistance program on a patient’s behalf shall be effective 7 until a date specified by the court, the date notice of 8 approval or denial of an application for health insurance 9 coverage through a private insurer, or for a public assistance 10 program is received by a qualified employee of the receiving 11 facility, or the date that an attending physician certifies 12 that the patient is able to consent to the application for a 13 public assistance program. 14 The bill provides immunity from civil or criminal liability 15 to a person acting in good faith according to the provisions of 16 the bill. Immunity from licensee discipline is also provided 17 for licensees acting in good faith. 18 The bill is not to be construed to require a health care 19 facility to accept the transfer or admission of a patient 20 unless otherwise ordered by a court of competent jurisdiction; 21 to repeal, abrogate, or impair the operation of any other 22 federal or state laws governing the transfer, admission, or 23 discharge of a patient to or from a care facility unless 24 ordered by a court of competent jurisdiction; or to infringe 25 upon the rights of patients under federal or state law relating 26 to the involuntary transfer, admission, or discharge to or from 27 a care facility. 28 The bill requires the department of health and human 29 services to adopt rules to administer the bill. 30 -10- LSB 5341YC (8) 91 ak/ko 10/ 10