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

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

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

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

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

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

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

H.F. 2562 1. Require a care facility to accept the transfer or 1 admission of a patient. 2 2. Repeal, abrogate, or impair the operation of any other 3 federal or state laws governing the transfer, admission, or 4 discharge of a patient to or from a care facility. 5 3. Infringe upon the rights of a patient under federal or 6 state law relating to the involuntary transfer, admission, or 7 discharge to or from a care facility. 8 Sec. 8. NEW SECTION . 144H.8 Rules. 9 The department may promulgate rules pursuant to chapter 17A 10 as necessary to administer this chapter. 11 -8- HF 2562 (3) 91 ak/ko/md 8/ 8