SSB 3096 (LSB 5341XC (6) 91)

SENATE FILE _____ 

BY  (PROPOSED COMMITTEE ON HEALTH AND HUMAN SERVICES BILL BY CHAIRPERSON WARME)

A BILL FOR

An Act relating to care facility placement decisions for certain adults.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  NEW SECTION.  144H.1  Definitions.
   For purposes of this chapter, unless the context otherwise requires:
   1.  “Authorized representative” means any of the following:
   a.  An agent as that term is defined in section 633B.102.
   b.  An attorney in fact as that term is defined in section 144B.1.
   c.  A conservator as that term is defined in section 633B.102.
   d.  A guardian as that term is defined in section 633B.102.
   e.  A public guardian as that term is defined in chapter 231E.
   2.  “Care facility” means a facility that provides a patient with health-related and personal care services, including any of the following:
   a.  A facility providing home and community-based services.
   b.  A hospital.
   c.  A medical clinic.
   d.  A nursing facility.
   e.  A rehabilitation facility as that term is defined in section 135C.1.
   f.  A residential care facility as that term is defined in section 135C.1.
   3.  “Department” means the department of health and human services.
   4.  “Patient” means an adult who is receiving health-related or personal care services from a care facility.
   5.  “Person authorized to consent” means a member of any of the following groups of individuals, in order of priority, who is willing and able to consent, refuse to consent, or withdraw consent on a patient’s behalf:
   a.  The patient’s spouse.
   b.  An adult child or stepchild of the patient, or, if the patient has more than one adult child or stepchild, the decision agreed to by a majority of the adult children and stepchildren reasonably available for consultation with the patient’s physician.
   c.  A parent or parents of a patient, if one or both parents are reasonably available for consultation with the patient’s physician.
   d.  An adult sibling or stepsibling of the patient or, if the patient has more than one adult sibling or stepsibling, the decision agreed to by a majority of the adult siblings and stepsiblings who are reasonably available for consultation with the patient’s physician.
   6.  “Placement” means the admission, discharge, or transfer of a patient.
   7.  “Public assistance program” means a state or federally funded program including but not limited to:
   a.  The Medicaid program as that term is defined in section 249A.2.
   b.  Medicare pursuant to the federal government health insurance program established under Tit. XVIII of the Social Security Act.
   c.  A medical benefits package pursuant to 38 C.F.R. §17.38.
   8.  “Unable to consent” means a patient is unable to do any of the following:
   a.  Make rational and competent decisions regarding care facility placement, and options for health insurance coverage for recommended care.
   b.  Communicate, by any means, decisions regarding care facility placement, and options for health insurance coverage for recommended care.
    Sec. 2.  NEW SECTION.  144H.2  Inability to consent —— certification.
   Upon examination of a patient, a physician licensed under chapter 148 may certify in the patient’s medical records that in the professional opinion of the physician all of the following are true:
   1.  The patient is unable to consent.
   2.  Despite good-faith efforts, an authorized representative for the patient has not been located by the physician.
   3.  It is in the patient’s best interests to be discharged from the patient’s current care facility and to be transferred or admitted to a care facility recommended by the physician.
    Sec. 3.  NEW SECTION.  144H.3  Person authorized to consent —— powers and duties.
   1.  Upon a physician’s certification pursuant to section 144H.2, a person authorized to consent is authorized to do any of the following:
   a.  Make decisions regarding the patient’s care facility placement.
   b.  Assist the patient in applying for health insurance coverage through a private insurer, or applying for a public assistance program, as necessary to facilitate the patient’s care facility placement.
   c.  Take any other action expressly authorized by the patient.
   2.  A person authorized to consent shall act in good faith and must consider all of the following:
   a.  The best interests of the patient.
   b.  The patient’s rights.
   c.  The patient’s wishes, if known.
   3.  The authority of a person authorized to consent shall expire upon the earliest of any of the following:
   a.  The date that the patient’s care facility placement as decided by the person authorized to consent is completed, and notice of approval or denial of an application for health insurance coverage through a private insurer, or for a public assistance program, if applicable, is received by a qualified employee of the receiving care facility.
   b.  An authorized representative, or a person authorized to consent who has higher priority, has been located.
    Sec. 4.  NEW SECTION.  144H.4  Care facility —— duties.
   A social worker, discharge planner, or other qualified employee as designated by a patient’s current care facility shall do all of the following with respect to a person authorized to consent:
   1.  Inform the person of the person’s powers and duties pursuant to this chapter.
   2.  Assist the person with identifying a receiving care facility for the patient that can provide the least restrictive and appropriate level of care, as recommended by the physician under section 144H.2, for the patient and consented to by a social worker, intake coordinator, or other qualified employee of the receiving care facility.
    Sec. 5.  NEW SECTION.  144H.5  Petition for court order.
   1.  After good-faith efforts to locate an authorized representative for the patient or a person authorized to consent, a care facility or attending physician may petition a court of competent jurisdiction to order the patient’s care facility placement.
   2.  The petition made must include the following information:
   a.  The name, age, and address where the patient resides, if known to the petitioner.
   b.  The name, address, and county of residence of the petitioner.
   c.  The relationship of the petitioner to the patient.
   d.  The address where the patient can be found, if different from the patient’s residential address.
   e.  A physician’s certification pursuant to section 144H.2.
   f.  An affidavit from the patient’s attending physician, that upon an examination of the patient, all of the following are true:
   (1)  The patient is unable to consent.
   (2)  The patient has not identified, and despite good-faith efforts the attending physician has been unable to locate, an authorized representative or a person authorized to consent.
   (3)  The receiving care facility placement recommended by the attending physician is in the patient’s best interests.
   (4)  The receiving care facility placement recommended by the attending physician will provide the least restrictive and most appropriate level of care for the patient, and is within a reasonable proximity to the patient’s residence, if applicable.
   g.  An affidavit from a social worker, discharge planner, or other qualified employee as designated by the patient’s current care facility attesting to all of the following:
   (1)  The patient has not identified, and despite good-faith efforts the current care facility has been unable to locate, an authorized representative or a person authorized to consent.
   (2)  The receiving care facility placement recommended by the attending physician will provide the least restrictive and most appropriate level of care for the patient.
   (3)  Other care facilities within a reasonable proximity to the patient’s residence were considered for placement, if applicable.
   h.  An affidavit from a social worker, intake coordinator, or other qualified employee of the receiving care facility recommended by the patient’s attending physician attesting to all of the following:
   (1)  The receiving care facility is the most appropriate facility available for the patient.
   (2)  The receiving care facility can provide the least restrictive and most appropriate level of care to the patient.
   (3)  The receiving care facility consents to the transfer or admission of the patient.
   i.  The name and address of the receiving care facility recommended by the attending physician.
   3.  The court shall grant the petition if the court finds all of the following:
   a.  The patient is unable to consent.
   b.  Despite good-faith efforts by the attending physician and the patient’s current care facility, an authorized representative or person authorized to consent has not been located.
   c.  Placement in the receiving care facility recommended by the patient’s attending physician is in the patient’s best interest.
   d.  Placement in the receiving care facility recommended by the patient’s attending physician will provide the least restrictive and most appropriate level of care for the patient.
   e.  A social worker, intake coordinator, or other qualified employee of the receiving care facility recommended by the patient’s attending physician has consented to the admission of the patient.
   4.  If the court grants the petition under subsection 3, the court shall also order, if necessary, that a qualified employee of the receiving care facility has the authority to apply for a public assistance program on the patient’s behalf.
   5.  An order authorizing placement pursuant to this section shall remain in effect until the earliest of any of the following:
   a.  A date specified by the court not to exceed thirty calendar days from the date of issuance of the order.
   b.  The date the patient’s placement in the receiving care facility as ordered by the court is completed.
   c.  The date an attending physician certifies that the patient is able to consent to the patient’s placement in the receiving care facility.
   6.  An order authorizing a qualified employee of a receiving facility to apply for a public assistance program on a patient’s behalf pursuant to this section shall remain in effect until the earliest of any of the following:
   a.  A date specified by the court.
   b.  Notice of approval or denial of an application for health insurance coverage through a private insurer, or for a public assistance program is received by a qualified employee of the receiving facility.
   c.  The date that an attending physician certifies that the patient is able to consent to the application for a public assistance program.
    Sec. 6.  NEW SECTION.  144H.6  Immunity —— liability and professional discipline.
   1.  A person acting in good faith pursuant to this chapter shall not be subject to civil or criminal liability.
   2.  A licensee under chapter 148 acting in good faith pursuant to this chapter shall not be subject to licensee discipline.
    Sec. 7.  NEW SECTION.  144H.7  Construction.
   This chapter shall not be construed to do any of the following:
   1.  Require a care facility to accept the transfer or admission of a patient, unless otherwise ordered by a court of competent jurisdiction.
   2.  Repeal, abrogate, or impair the operation of any other federal or state laws governing the transfer, admission, or discharge of a patient to or from a care facility.
   3.  Infringe upon the rights of a patient under federal or state law relating to the involuntary transfer, admission, or discharge to or from a care facility.
    Sec. 8.  NEW SECTION.  144H.8  Rules.
   The department shall promulgate rules pursuant to chapter 17A as necessary to administer this chapter.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
   This bill relates to care facility placement decisions for certain adults.
   The bill defines “authorized representative” as an agent, attorney in fact, conservator, or guardian. “Person authorized to consent” (authorized person) is defined as a member of any of the following groups of individuals, in order of priority, that is willing and able to consent, refuse to consent, or withdraw consent on a patient’s behalf: the patient’s spouse, the adult children or stepchildren, the parent or parents of a patient, or the adult siblings or stepsiblings of the patient. “Care facility” is defined as a facility that provides a patient with health-related and personal care services, including a facility providing home and community-based services, hospital, medical clinic, nursing facility, rehabilitation facility, or residential care facility. “Placement” is defined as the admission, discharge, or transfer of a patient. 
   The bill provides that a physician licensed under the laws of this state may certify in a patient’s record that the patient is unable to consent, an authorized representative for the patient has not been located by the physician despite good-faith efforts, and that it is in the patient’s best interests to be discharged from the patient’s current care facility and transferred or admitted to a care facility recommended by the physician. “Patient” and “unable to consent” are defined in the bill. 
   The bill provides that an authorized person shall act in good faith and in the best interests of the patient, consistent with the patient’s rights and wishes. The bill authorizes the authorized person, upon the physician’s certification, to make care facility placement decisions and assist the patient in applying for health insurance coverage through private insurance, or for a public assistance program, as necessary to facilitate placement.
   The bill provides that the authority of an authorized person expires when the placement decided by the authorized person is completed and notice of approval or denial of an application for health insurance coverage through a private insurer, or for a public assistance program, if applicable, is received by a qualified employee of the receiving care facility, or when an authorized representative or authorized person of higher priority is located.
   The bill requires a social worker, discharge planner, or other qualified employee as designated by the current care facility of the patient to inform an authorized person of the person’s powers and duties and to assist the person with identifying a receiving care facility for the patient that will provide the least restrictive and appropriate level of care for the patient as recommended by the certifying physician.
   After a good-faith effort to locate an authorized representative or authorized person, the bill allows an attending physician or a care facility to petition a court of competent jurisdiction to order placement. The petition must include certain information about the patient, the petitioner, the current care facility, and the proposed receiving care facility, and be supported by affidavits from an attending physician, a social worker, discharge planner, or other qualified employee from both the current and the proposed receiving care facility. The bill requires the court to grant the petition if it finds that the patient is unable to consent, no authorized representative for the patient or authorized person has been located by the attending physician and the patient’s current care facility despite good-faith efforts, placement in the receiving care facility recommended to the court by the patient’s attending physician is in the best interests of the patient, and will provide the least restrictive and most appropriate level of care for the patient. A social worker, intake coordinator, or other qualified employee of the proposed receiving care facility must consent to the admission of the patient. If a court order authorizes a patient’s transfer to the receiving care facility, the authority, if necessary, to apply for a public assistance program on the patient’s behalf shall transfer pursuant to court order to a qualified employee of the receiving care facility.
   The bill provides that the court’s order shall be effective until a date specified by the court not to exceed 30 calendar days from the date of the issuance of the order, the completion of any placement of the patient in the receiving care facility as ordered, or the date that a physician certifies that the patient is able to consent to the patient’s placement in a care facility.
   The bill provides that a court order authorizing a qualified employee of a receiving facility to apply for a public assistance program on a patient’s behalf shall be effective until a date specified by the court, the date notice of approval or denial of an application for health insurance coverage through a private insurer, or for a public assistance program is received by a qualified employee of the receiving facility, or the date that an attending physician certifies that the patient is able to consent to the application for a public assistance program.
   The bill provides immunity from civil or criminal liability to a person acting in good faith according to the provisions of the bill. Immunity from licensee discipline is also provided for licensees acting in good faith.
   The bill is not to be construed to require a health care facility to accept the transfer or admission of a patient unless otherwise ordered by a court of competent jurisdiction; to repeal, abrogate, or impair the operation of any other federal or state laws governing the transfer, admission, or discharge of a patient to or from a care facility unless ordered by a court of competent jurisdiction; or to infringe upon the rights of patients under federal or state law relating to the involuntary transfer, admission, or discharge to or from a care facility.
   The bill requires the department of health and human services to adopt rules to administer the bill.