Bill Text: IA SF90 | 2017-2018 | 87th General Assembly | Introduced
Bill Title: A bill for an act relating to the designation of a caregiver relating to a patient’s inpatient stay at a hospital.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2017-01-18 - Subcommittee: Greene, Garrett, and Jochum. S.J. 99. [SF90 Detail]
Download: Iowa-2017-SF90-Introduced.html
Senate File 90 - Introduced SENATE FILE BY JOCHUM A BILL FOR 1 An Act relating to the designation of a caregiver relating to a 2 patient's inpatient stay at a hospital. 3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: TLSB 1470XS (1) 87 pf/nh PAG LIN 1 1 Section 1. NEW SECTION. 144E.1 Definitions. 1 2 As used in this chapter, unless the context otherwise 1 3 requires: 1 4 1. "After=care assistance" means any assistance provided 1 5 by a caregiver to a patient following the patient's discharge 1 6 from a hospital that is related to the patient's condition 1 7 at the time of discharge, including but not limited to 1 8 assisting with basic activities of daily living, assisting 1 9 with instrumental activities of daily living, and performing 1 10 other tasks including but not limited to managing wound care, 1 11 assisting in the administering of medications, and operating 1 12 medical equipment, as determined to be appropriate by the 1 13 patient's discharging physician or other licensed health care 1 14 professional. 1 15 2. "Caregiver" means any individual designated as a 1 16 caregiver by a patient who provides after=care assistance to a 1 17 patient in the patient's residence. "Caregiver" includes but is 1 18 not limited to a relative, spouse, partner, friend, or neighbor 1 19 who has a significant relationship with the patient. 1 20 3. "Discharge" means a patient's exit or release from a 1 21 hospital to the patient's residence following an inpatient 1 22 admission. 1 23 4. "Entry" means a patient's admission into a hospital for 1 24 the purposes of receiving inpatient medical care. 1 25 5. "Facility" means a health care facility as defined in 1 26 section 135C.1, an elder group home as defined in section 1 27 231B.1, or an assisted living program as defined in section 1 28 231C.2. 1 29 6. "Hospital" means a licensed hospital as defined in 1 30 section 135B.1. 1 31 7. "Residence" means the dwelling that the patient considers 1 32 to be the patient's home. "Residence" does not include any 1 33 rehabilitation facility, hospital, nursing home, assisted 1 34 living facility, or group home licensed by the department of 1 35 inspections and appeals. 2 1 Sec. 2. NEW SECTION. 144E.2 Caregiver ==== opportunity to 2 2 designate. 2 3 1. a. A hospital shall provide each patient or, if 2 4 applicable, the patient's legal guardian, with an opportunity 2 5 to designate at least one caregiver within twenty=four hours 2 6 following the patient's entry into a hospital, and prior to 2 7 the patient's discharge or transfer to another hospital or 2 8 facility. 2 9 b. If the patient is unconscious or otherwise incapacitated 2 10 upon entry into the hospital, the hospital shall provide the 2 11 patient or the patient's legal guardian with an opportunity to 2 12 designate a caregiver within twenty=four hours following the 2 13 patient's recovery of consciousness or capacity. 2 14 c. If the patient or legal guardian declines to designate 2 15 a caregiver, the hospital shall promptly document this 2 16 declination in the patient's medical record. 2 17 d. If the patient or the patient's legal guardian designates 2 18 an individual as a caregiver, all of the following shall apply: 2 19 (1) The hospital shall promptly request the written consent 2 20 of the patient or the patient's legal guardian to release 2 21 medical information to the patient's caregiver following the 2 22 hospital's established procedures for releasing personal health 2 23 information and in compliance with all federal and state 2 24 laws. If the patient or the patient's legal guardian declines 2 25 to consent to release medical information to the patient's 2 26 caregiver, the hospital shall not be required to provide notice 2 27 to the caregiver under section 144E.3 or to provide information 2 28 contained in the patient's discharge plan to the caregiver 2 29 under section 144E.4. 2 30 (2) The hospital shall record the patient's designation of 2 31 caregiver, the relationship of the caregiver to the patient, 2 32 and the name, telephone number, and address of the patient's 2 33 caregiver in the patient's medical record. 2 34 e. A patient or the patient's legal guardian may elect to 2 35 change the designation of the patient's caregiver at any time, 3 1 and the hospital shall record such change in the patient's 3 2 medical record prior to the patient's discharge. 3 3 2. The designation of a caregiver by a patient or a 3 4 patient's legal guardian does not obligate the designated 3 5 individual to perform any after=care assistance for the 3 6 patient. 3 7 3. This section shall not be construed to require a patient 3 8 or a patient's legal guardian to designate any individual as a 3 9 caregiver. 3 10 Sec. 3. NEW SECTION. 144E.3 Notification of caregiver. 3 11 A hospital shall notify the patient's caregiver of the 3 12 patient's discharge or transfer to another hospital or facility 3 13 as soon as possible upon issuance of a discharge or transfer 3 14 order by the patient's attending physician and prior to the 3 15 patient's actual discharge or transfer to another hospital or 3 16 facility. If the hospital is unable to contact the caregiver, 3 17 the lack of contact shall not interfere with, delay, or 3 18 otherwise affect the medical care provided to the patient, or 3 19 an appropriate discharge or transfer of the patient. 3 20 Sec. 4. NEW SECTION. 144E.4 Instructions to caregiver. 3 21 1. a. As soon as possible and prior to a patient's 3 22 discharge from a hospital, the hospital shall consult with the 3 23 caregiver along with the patient regarding the caregiver's 3 24 capabilities and limitations and issue a discharge plan that 3 25 describes the patient's after=care assistance needs at the 3 26 patient's residence. At a minimum, the discharge plan shall 3 27 include: 3 28 (1) The name and contact information of the caregiver. 3 29 (2) A description of all after=care assistance tasks 3 30 necessary to maintain the patient's ability to reside at the 3 31 patient's residence. 3 32 (3) Contact information for any health care, community 3 33 resource, and long=term services and supports necessary to 3 34 successfully carry out the patient's discharge plan. 3 35 b. If the hospital is unable to contact the caregiver, 4 1 the lack of contact shall not interfere with, delay, or 4 2 otherwise affect the medical care provided to the patient, or 4 3 an appropriate discharge or transfer of the patient. 4 4 2. The hospital issuing the discharge plan shall offer 4 5 to provide a caregiver with instructions for all after=care 4 6 assistance tasks described in the discharge plan. At a 4 7 minimum, this instruction shall include: 4 8 a. A live demonstration or video instruction of the 4 9 after=care tasks, performed by a hospital employee or 4 10 an individual with whom the hospital has a contractual 4 11 relationship, who has the appropriate education and competency 4 12 in the task to be performed and is authorized to perform the 4 13 task, in a culturally=competent manner and in accordance with 4 14 the hospital's requirements to provide language access services 4 15 under state and federal law. 4 16 b. An opportunity for the caregiver to ask questions about 4 17 the after=care assistance tasks. 4 18 c. Answers to the caregiver's questions provided in 4 19 a culturally=competent manner and in accordance with the 4 20 hospital's requirements to provide language access services 4 21 under state and federal law. 4 22 Sec. 5. NEW SECTION. 144E.5 Adoption of rules. 4 23 The department of inspections and appeals, in consultation 4 24 with the department of public health, may adopt rules pursuant 4 25 to chapter 17A to administer this chapter including but not 4 26 limited to rules to further define the content and scope of any 4 27 instructions provided to caregivers under this chapter. 4 28 Sec. 6. NEW SECTION. 144E.6 Construction of chapter 4 29 relative to other health care directive. 4 30 Nothing in this chapter shall be construed to interfere with 4 31 the rights of an agent operating under a valid durable power of 4 32 attorney for health care pursuant to chapter 144B. 4 33 Sec. 7. NEW SECTION. 144E.7 Limitations. 4 34 1. Nothing in this chapter shall be construed to create 4 35 a private right of action against a hospital, a hospital 5 1 employee, or any consultant or contractor with whom a hospital 5 2 has a contractual relationship, or to limit or otherwise 5 3 supersede or replace existing rights or remedies under any 5 4 other provision of law. 5 5 2. Nothing in this chapter shall delay the appropriate 5 6 discharge or transfer of a patient. 5 7 3. Nothing in this chapter shall be construed to interfere 5 8 with or supersede a health care provider's instructions 5 9 regarding a Medicare=certified home health agency or any other 5 10 postacute care provider. 5 11 4. Nothing in this chapter shall be construed to grant 5 12 decision=making authority to a caregiver to determine the type 5 13 of provider or provider of the patient's posthospital care as 5 14 specified in the patient's discharge plan. 5 15 EXPLANATION 5 16 The inclusion of this explanation does not constitute agreement with 5 17 the explanation's substance by the members of the general assembly. 5 18 This bill relates to the designation of a caregiver relative 5 19 to an inpatient admission of a patient to a hospital to 5 20 provide after=care assistance to the patient upon discharge 5 21 of the patient to the patient's residence. The bill provides 5 22 definitions used in the new Code chapter 144E, including 5 23 "after=care assistance", "caregiver", "discharge", "entry", 5 24 "facility", "hospital", and "residence". 5 25 The bill requires a hospital to provide each patient or, if 5 26 applicable, the patient's legal guardian, with an opportunity 5 27 to designate at least one caregiver following the patient's 5 28 entry into a hospital, and prior to the patient's discharge 5 29 or transfer to another hospital or facility, and provides for 5 30 situations in which the patient is unconscious or otherwise 5 31 incapacitated or if the patient or patient's legal guardian 5 32 declines to designate a caregiver. If a patient or patient's 5 33 legal guardian designates a caregiver, the hospital is required 5 34 to promptly request the written consent of the patient or the 5 35 patient's legal guardian to release medical information to 6 1 the patient's caregiver following the hospital's established 6 2 procedures and in compliance with all federal and state 6 3 laws. If the patient or the patient's legal guardian declines 6 4 to consent to release medical information to the patient's 6 5 caregiver, the hospital is not required to provide notification 6 6 to the caregiver or to provide information contained in the 6 7 patient's discharge plan to the caregiver. The hospital is 6 8 required to record the patient's designation of caregiver, the 6 9 relationship of the caregiver to the patient, and the name, 6 10 telephone number, and address of the patient's caregiver in 6 11 the patient's medical record. The bill allows for a change in 6 12 the caregiver designation by a patient or the patient's legal 6 13 guardian at any time. The bill provides that the designation 6 14 of a caregiver by a patient or a patient's legal guardian 6 15 does not obligate the designated individual to perform any 6 16 after=care assistance for the patient and that the provisions 6 17 of the bill are not to be construed to require a patient or 6 18 a patient's legal guardian to designate any individual as a 6 19 caregiver. 6 20 Under the bill, a hospital is required to notify the 6 21 patient's caregiver of the patient's discharge or transfer to 6 22 another hospital or facility as soon as possible upon issuance 6 23 of a discharge or transfer order by the patient's attending 6 24 physician and prior to the patient's actual discharge or 6 25 transfer to another hospital or facility. If the hospital is 6 26 unable to contact the caregiver, the lack of contact shall not 6 27 interfere with, delay, or otherwise affect the medical care 6 28 provided to the patient, or an appropriate discharge of the 6 29 patient. 6 30 Under the bill, as soon as possible and prior to a patient's 6 31 discharge from a hospital, the hospital is required to consult 6 32 with the caregiver along with the patient regarding the 6 33 caregiver's capabilities and limitations and issue a discharge 6 34 plan that describes the patient's after=care assistance needs 6 35 at the patient's residence. The bill also requires specified 7 1 minimum instructions to be provided to the caregiver. 7 2 The bill directs the department of inspections and appeals 7 3 to adopt rules, in cooperation with the department of public 7 4 health, to administer the bill. The bill is not to be 7 5 construed to interfere with the rights of an agent operating 7 6 under a valid durable power of attorney for health care; 7 7 is not to be construed to create a private right of action 7 8 against a hospital, a hospital employee, or any consultant or 7 9 contractor with whom a hospital has a contractual relationship, 7 10 or to otherwise supersede or replace existing rights or 7 11 remedies under any other provision of law; shall not delay 7 12 the appropriate discharge or transfer of a patient; is not 7 13 to be construed to interfere with or supersede a health care 7 14 provider's instructions regarding a Medicare=certified home 7 15 health agency or any other postacute care provider; and is 7 16 not to be construed to grant decision=making authority to a 7 17 caregiver to determine the type of provider or provider of 7 18 the patient's posthospital care as specified in the patient's 7 19 discharge plan. LSB 1470XS (1) 87 pf/nh
