Bill Text: IA SF84 | 2019-2020 | 88th General Assembly | Introduced

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Bill Title: A bill for an act providing for the designation of a lay caregiver relating to a patient's inpatient stay at a hospital. (See SF 210.)

Spectrum: Partisan Bill (Republican 1-0)

Status: (Introduced - Dead) 2019-02-07 - Committee report approving bill, renumbered as SF 210. S.J. 260. [SF84 Detail]

Download: Iowa-2019-SF84-Introduced.html

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Senate File 84 - Introduced
SENATE FILE 84
BY SEGEBART
A BILL FOR
An Act providing for the designation of a lay caregiver
relating to a patient’s inpatient stay at a hospital.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
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Section 1. NEW SECTION . 144F.1 Definitions.
As used in this chapter, unless the context otherwise
requires:
1. “Aftercare assistance” means any assistance provided
by a lay caregiver to a patient following discharge of the
patient that are tasks directly related to the patient’s
condition at the time of discharge, do not require a licensed
professional, and are determined to be appropriate by the
patient’s discharging physician or other licensed health care
professional.
2. “Discharge” means the exit or release of a patient from
inpatient care in a hospital to the residence of the patient.
3. “Facility” means a health care facility as defined in
section 135C.1, an elder group home as defined in section
231B.1, or an assisted living program as defined in section
231C.2.
4. “Hospital” means a licensed hospital as defined in
section 135B.1.
5. “Lay caregiver” means an individual, eighteen years of
age or older, who is designated as a lay caregiver under this
chapter by a patient or the patient’s legal representative, and
who is willing and able to perform aftercare assistance for the
patient at the patient’s residence following discharge.
6. “Legal representative” means, in order of priority,
an attorney in fact under a durable power of attorney for
health care pursuant to chapter 144B or, if no durable power
of attorney for health care has been executed pursuant to
chapter 144B or if the attorney in fact is unavailable, a legal
guardian appointed pursuant to chapter 633.
7. “Patient” means an individual who is receiving or who has
received inpatient medical care in a hospital.
8. “Residence” means the dwelling that a patient considers
to be the patient’s home. “Residence” does not include any
rehabilitation facility, hospital, or facility.
Sec. 2. NEW SECTION . 144F.2 Discharge policies ——
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opportunity to designate lay caregiver.
1. a. A hospital shall adopt and maintain evidence-based
discharge policies and procedures. At a minimum, the policies
and procedures shall provide for an assessment of the patient’s
ability for self-care after discharge and, as part of the
assessment, shall provide a patient, or if applicable the
patient’s legal representative, with an opportunity to
designate one lay caregiver prior to discharge of the patient.
b. A legal representative who is an agent under a durable
power of attorney for health care pursuant to chapter 144B
shall be given the opportunity to designate a lay caregiver
in lieu of the patient’s designation of a lay caregiver only
if, consistent with chapter 144B, in the judgment of the
attending physician, the patient is unable to make the health
care decision. A legal representative who is a guardian shall
be given the opportunity to designate a lay caregiver in lieu
of the patient’s designation of a lay caregiver to the extent
consistent with the powers and duties granted the guardian
pursuant to section 633.635.
2. If a patient or the patient’s legal representative
declines to designate a lay caregiver, the hospital shall
document the declination in the patient’s medical record and
the hospital shall be deemed to be in compliance with this
section.
3. If a patient or the patient’s legal representative
designates a lay caregiver, the hospital shall do all of the
following:
a. Record in the patient’s medical record the designation of
the lay caregiver, in accordance with the hospital’s policies
and procedures, which may include information such as the
relationship of the lay caregiver to the patient, and the name,
telephone number, and address of the lay caregiver.
b. (1) Request written consent from the patient or the
patient’s legal representative to release medical information
to the lay caregiver in accordance with the hospital’s
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established procedures for releasing a patient’s personal
health information and in compliance with all applicable state
and federal laws.
(2) If a patient or the patient’s legal representative
declines to consent to the release of medical information to
the lay caregiver, the hospital is not required to provide
notice to the lay caregiver under section 144F.3 or to consult
with or provide information contained in the patient’s
discharge plan to the lay caregiver under section 144F.4.
4. A patient or the patient’s legal representative may
change the designation of a lay caregiver if the lay caregiver
becomes incapacitated.
5. The designation of an individual as a lay caregiver under
this section does not obligate the individual to perform any
aftercare assistance for the patient.
6. This section shall not be construed to require a patient
or the patient’s legal representative to designate a lay
caregiver.
Sec. 3. NEW SECTION . 144F.3 Notification of lay caregiver
of discharge.
If a lay caregiver is designated under section 144F.2, the
hospital shall, in accordance with the hospital’s established
policies and procedures, attempt to notify the lay caregiver of
the discharge of the patient as soon as practicable.
Sec. 4. NEW SECTION . 144F.4 Aftercare assistance
instructions to lay caregiver.
1. If a lay caregiver is designated under section 144F.2, as
soon as practicable prior to discharge of a patient, a hospital
shall attempt to do all of the following:
a. Consult with the patient’s lay caregiver to prepare the
lay caregiver for the aftercare assistance the lay caregiver
may provide.
b. Issue a discharge plan that describes the aftercare
assistance needs of the patient and offer to provide the lay
caregiver with instructions for the aftercare assistance tasks
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described in the discharge plan and the opportunity for the lay
caregiver to ask questions regarding such tasks.
2. The inability of a hospital to consult with a patient’s
lay caregiver shall not interfere with, delay, or otherwise
affect the medical care provided to the patient or the
patient’s discharge.
Sec. 5. NEW SECTION . 144F.5 Hospital discharge process ——
evidence-based practices.
A hospital’s discharge process may incorporate established
evidence-based practices, including but not limited to any of
the following:
1. The standards for accreditation adopted by the joint
commission on the accreditation of health care organizations
or any other nationally recognized hospital accreditation
organization.
2. The conditions of participation for hospitals adopted by
the centers for Medicare and Medicaid services of the United
States department of health and human services.
Sec. 6. NEW SECTION . 144F.6 Construction of chapter
relative to other health care directives.
Nothing in this chapter shall be construed to interfere with
the authority or responsibilities of an agent operating under
a valid durable power of attorney for health care pursuant to
chapter 144B or of the powers and duties granted to a guardian
pursuant to section 633.635.
Sec. 7. NEW SECTION . 144F.7 Limitations.
1. Nothing in this chapter shall be construed to create
a private right of action against a hospital, a hospital
employee, or any consultant or contractor with whom a hospital
has a contractual relationship, or to limit or otherwise
supersede or replace existing rights or remedies under any
other provision of law.
2. Nothing in this chapter shall delay the appropriate
discharge or transfer of a patient.
3. Nothing in this chapter shall be construed to interfere
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with or supersede a health care provider’s instructions
regarding a Medicare-certified home health agency or any other
post-acute care provider.
4. Nothing in this chapter shall be construed to grant
decision-making authority to a lay caregiver to determine the
type of provider or provider of the patient’s post-hospital
care as specified in the patient’s discharge plan.
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 the designation of a lay caregiver
relative to an inpatient stay of a patient in a hospital to
provide aftercare assistance to the patient upon discharge of
the patient to the patient’s residence. The bill provides
definitions used in new Code chapter 144F.
The bill requires a hospital to adopt and maintain
evidence-based discharge policies and procedures that provide
for an assessment of the patient’s ability for self-care
after discharge and provide the patient or, if applicable,
the patient’s legal representative, with an opportunity to
designate one lay caregiver prior to the patient’s discharge
from the hospital. The bill provides for the priority order
in determining who may designate a lay caregiver between
the patient, an agent under a durable power of attorney for
health care, or a guardian and provides that if a patient or
legal representative declines to designate a lay caregiver
the hospital is required to document the declination in the
patient’s medical record and the hospital is then deemed in
compliance with the designation provision.
If a patient or the patient’s legal representative
designates a lay caregiver, the hospital is required to
record the designation in the patient’s medical record, and to
request the written consent of the patient or the patient’s
legal representative to release medical information to the
lay caregiver in accordance with the hospital’s established
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procedures and in compliance with all federal and state laws.
If the patient or the patient’s legal representative declines
to consent to release medical information to the lay caregiver,
the hospital is not required to provide notice to the lay
caregiver of the patient’s discharge or to provide information
contained in the patient’s discharge plan to the lay caregiver.
The bill allows for a change in the designation of a lay
caregiver by the patient or the patient’s legal representative
if the lay caregiver becomes incapacitated. Under the bill,
the designation of a lay caregiver does not obligate the
designated individual to perform any aftercare assistance for
the patient and the bill is not to be construed to require a
patient or a patient’s legal representative to designate a lay
caregiver.
Under the bill, a hospital is required to notify the
designated lay caregiver of the patient’s discharge as soon as
practicable. If a lay caregiver is designated, the hospital
is required as soon as practicable prior to the patient’s
discharge from a hospital, to attempt to consult with the
lay caregiver to prepare the lay caregiver for the aftercare
assistance that may be provided by the lay caregiver; and
to issue a discharge plan and offer to provide the lay
caregiver with instructions for the aftercare assistance tasks
described in the discharge plan and the opportunity to ask
questions. The inability of a hospital to consult with a lay
caregiver shall not interfere with, delay, or otherwise affect
the medical care provided to the patient or the patient’s
discharge.
A hospital’s discharge process adopted and maintained under
the bill may incorporate established evidence-based practices
including those specified in the bill. The bill is not to be
construed to interfere with the authority or responsibilities
of an agent operating under a valid durable power of attorney
for health care or with the power and duties granted a
guardian; or to create a private right of action against a
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hospital, a hospital employee, or any consultant or contractor
with whom a hospital has a contractual relationship or to limit
or otherwise supersede or replace existing rights or remedies
under other provisions of law. Additionally, the bill shall
not delay the appropriate discharge or transfer of a patient;
shall not be construed to interfere with or supersede a health
care provider’s instructions regarding a Medicare-certified
home health agency or any other post-acute care provider; and
shall not be construed to grant decision-making authority to a
lay caregiver to determine the type of provider or provider of
the patient’s post-hospital care as specified in the patient’s
discharge plan.
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