Bill Text: VA HB2130 | 2013 | Regular Session | Prefiled
Bill Title: Nursing homes; implementation of voluntary electronic monitoring in residents' rooms.
Spectrum: Partisan Bill (Democrat 3-0)
Status: (Passed) 2013-03-21 - Governor: Acts of Assembly Chapter text (CHAP0674) [HB2130 Detail]
Download: Virginia-2013-HB2130-Prefiled.html
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13102431D Be it enacted by the General Assembly of Virginia: 1. That §§32.1-127, 32.1-138, and 32.1-138.1 of the Code of Virginia are amended and reenacted as follows: §32.1-127. Regulations. A. The regulations promulgated by the Board to carry out the provisions of this article shall be in substantial conformity to the standards of health, hygiene, sanitation, construction and safety as established and recognized by medical and health care professionals and by specialists in matters of public health and safety, including health and safety standards established under provisions of Title XVIII and Title XIX of the Social Security Act, and to the provisions of Article 2 (§32.1-138 et seq.). B. Such regulations: 1. Shall include minimum standards for (i) the construction
and maintenance of hospitals, nursing homes and certified nursing facilities to
assure the environmental protection and the life safety of its patients,
employees, and the public; (ii) the operation, staffing and equipping of
hospitals, nursing homes and certified nursing facilities; (iii) qualifications
and training of staff of hospitals, nursing homes and certified nursing
facilities, except those professionals licensed or certified by the Department
of Health Professions; (iv) conditions under which a hospital or nursing home
may provide medical and nursing services to patients in their places of
residence; and (v) policies related to infection prevention, disaster
preparedness, and facility security of hospitals, nursing homes, and certified
nursing facilities. For purposes of this paragraph, facilities in which 2. Shall provide that at least one physician who is licensed to practice medicine in this Commonwealth shall be on call at all times, though not necessarily physically present on the premises, at each hospital which operates or holds itself out as operating an emergency service; 3. May classify hospitals and nursing homes by type of specialty or service and may provide for licensing hospitals and nursing homes by bed capacity and by type of specialty or service; 4. Shall also require that each hospital establish a protocol for organ donation, in compliance with federal law and the regulations of the Centers for Medicare & Medicaid Services (CMS), particularly 42 C.F.R. § 482.45. Each hospital shall have an agreement with an organ procurement organization designated in CMS regulations for routine contact, whereby the provider's designated organ procurement organization certified by CMS (i) is notified in a timely manner of all deaths or imminent deaths of patients in the hospital and (ii) is authorized to determine the suitability of the decedent or patient for organ donation and, in the absence of a similar arrangement with any eye bank or tissue bank in Virginia certified by the Eye Bank Association of America or the American Association of Tissue Banks, the suitability for tissue and eye donation. The hospital shall also have an agreement with at least one tissue bank and at least one eye bank to cooperate in the retrieval, processing, preservation, storage, and distribution of tissues and eyes to ensure that all usable tissues and eyes are obtained from potential donors and to avoid interference with organ procurement. The protocol shall ensure that the hospital collaborates with the designated organ procurement organization to inform the family of each potential donor of the option to donate organs, tissues, or eyes or to decline to donate. The individual making contact with the family shall have completed a course in the methodology for approaching potential donor families and requesting organ or tissue donation that (a) is offered or approved by the organ procurement organization and designed in conjunction with the tissue and eye bank community and (b) encourages discretion and sensitivity according to the specific circumstances, views, and beliefs of the relevant family. In addition, the hospital shall work cooperatively with the designated organ procurement organization in educating the staff responsible for contacting the organ procurement organization's personnel on donation issues, the proper review of death records to improve identification of potential donors, and the proper procedures for maintaining potential donors while necessary testing and placement of potential donated organs, tissues, and eyes takes place. This process shall be followed, without exception, unless the family of the relevant decedent or patient has expressed opposition to organ donation, the chief administrative officer of the hospital or his designee knows of such opposition, and no donor card or other relevant document, such as an advance directive, can be found; 5. Shall require that each hospital that provides obstetrical services establish a protocol for admission or transfer of any pregnant woman who presents herself while in labor; 6. Shall also require that each licensed hospital develop and implement a protocol requiring written discharge plans for identified, substance-abusing, postpartum women and their infants. The protocol shall require that the discharge plan be discussed with the patient and that appropriate referrals for the mother and the infant be made and documented. Appropriate referrals may include, but need not be limited to, treatment services, comprehensive early intervention services for infants and toddlers with disabilities and their families pursuant to Part H of the Individuals with Disabilities Education Act, 20 U.S.C. §1471 et seq., and family-oriented prevention services. The discharge planning process shall involve, to the extent possible, the father of the infant and any members of the patient's extended family who may participate in the follow-up care for the mother and the infant. Immediately upon identification, pursuant to §54.1-2403.1, of any substance-abusing, postpartum woman, the hospital shall notify, subject to federal law restrictions, the community services board of the jurisdiction in which the woman resides to appoint a discharge plan manager. The community services board shall implement and manage the discharge plan; 7. Shall require that each nursing home and certified nursing facility fully disclose to the applicant for admission the home's or facility's admissions policies, including any preferences given; 8. Shall require that each licensed hospital establish a protocol relating to the rights and responsibilities of patients which shall include a process reasonably designed to inform patients of such rights and responsibilities. Such rights and responsibilities of patients, a copy of which shall be given to patients on admission, shall be based on Joint Commission on Accreditation of Healthcare Organizations' standards; 9. Shall establish standards and maintain a process for designation of levels or categories of care in neonatal services according to an applicable national or state-developed evaluation system. Such standards may be differentiated for various levels or categories of care and may include, but need not be limited to, requirements for staffing credentials, staff/patient ratios, equipment, and medical protocols; 10. Shall require that each nursing home and certified nursing facility train all employees who are mandated to report adult abuse, neglect, or exploitation pursuant to §63.2-1606 on such reporting procedures and the consequences for failing to make a required report; 11. Shall permit hospital personnel, as designated in medical staff bylaws, rules and regulations, or hospital policies and procedures, to accept emergency telephone and other verbal orders for medication or treatment for hospital patients from physicians, and other persons lawfully authorized by state statute to give patient orders, subject to a requirement that such verbal order be signed, within a reasonable period of time not to exceed 72 hours as specified in the hospital's medical staff bylaws, rules and regulations or hospital policies and procedures, by the person giving the order, or, when such person is not available within the period of time specified, co-signed by another physician or other person authorized to give the order; 12. Shall require, unless the vaccination is medically contraindicated or the resident declines the offer of the vaccination, that each certified nursing facility and nursing home provide or arrange for the administration to its residents of (i) an annual vaccination against influenza and (ii) a pneumococcal vaccination, in accordance with the most recent recommendations of the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention; 13. Shall require that each nursing home and certified nursing facility register with the Department of State Police to receive notice of the registration or reregistration of any sex offender within the same or a contiguous zip code area in which the home or facility is located, pursuant to §9.1-914; 14. Shall require that each nursing home and certified nursing facility ascertain, prior to admission, whether a potential patient is a registered sex offender, if the home or facility anticipates the potential patient will have a length of stay greater than three days or in fact stays longer than three days; 15. Shall require that each licensed hospital include in its
visitation policy a provision allowing each adult patient to receive visits
from any individual from whom the patient desires to receive visits, subject to
other restrictions contained in the visitation policy including, but not
limited to, those related to the patient's medical condition and the number of
visitors permitted in the patient's room simultaneously; 16. Shall require that each nursing home and certified nursing facility shall, upon the request of the facility's family council, send notices and information about the family council mutually developed by the family council and the administration of the nursing home or certified nursing facility, and provided to the facility for such purpose, to the listed responsible party or a contact person of the resident's choice up to six times per year. Such notices may be included together with a monthly billing statement or other regular communication. Notices and information shall also be posted in a designated location within the nursing home or certified nursing facility; and 17. Shall include provisions for the use of electronic monitoring devices by residents of nursing homes and certified nursing facilities. Such regulations shall protect the rights of residents of nursing homes and certified nursing facilities and shall include (i) provisions for the notification of each resident of a nursing home or certified nursing facility of the right of any resident to implement electronic monitoring in any room in which he resides, the right of any resident to consent or refuse to consent to electronic monitoring in any room in which he resides, and the options available to any resident should he refuse to consent to electronic monitoring in a room in which he resides, including transfer to a room in which electronic monitoring has not been implemented; (ii) a process whereby a resident who is capable of making an informed decision or, if a resident is not capable of making an informed decision, the resident's authorized representative may consent in writing to electronic monitoring in the room in which he resides; (iii) procedures for the protection of the rights of a resident who refuses to consent to electronic monitoring in any room in which he resides, including provisions for transferring either the resident who seeks to implement electronic monitoring or the resident who declines to consent to electronic monitoring to another room, upon notice by such resident; (iv) requirements for a written form releasing the nursing home or certified nursing facility from civil liability for violation of the privacy rights of the resident who chooses to implement electronic monitoring in the room in which he resides and any other resident of the same room; and (v) provisions governing training and notification of nursing home and certified nursing facility staff and others of any duty to report suspected abuse or neglect of an adult pursuant to §63.2-1606. C. Upon obtaining the appropriate license, if applicable, licensed hospitals, nursing homes, and certified nursing facilities may operate adult day care centers. D. All facilities licensed by the Board pursuant to this article which provide treatment or care for hemophiliacs and, in the course of such treatment, stock clotting factors, shall maintain records of all lot numbers or other unique identifiers for such clotting factors in order that, in the event the lot is found to be contaminated with an infectious agent, those hemophiliacs who have received units of this contaminated clotting factor may be apprised of this contamination. Facilities which have identified a lot which is known to be contaminated shall notify the recipient's attending physician and request that he notify the recipient of the contamination. If the physician is unavailable, the facility shall notify by mail, return receipt requested, each recipient who received treatment from a known contaminated lot at the individual's last known address. §32.1-138. Enumeration; posting of policies; staff training; responsibilities devolving on guardians, etc.; exceptions; certification of compliance. A. The governing body of a nursing home facility required to
be licensed under the provisions of Article 1 (§32.1-123 et seq.) 1. Is fully informed, as evidenced by the patient's written acknowledgment, prior to or at the time of admission and during his stay, of his rights and of all rules and regulations governing patient conduct and responsibilities; 2. Is fully informed, as evidenced by the patient's written acknowledgment, prior to or at the time of admission and during his stay, of services available in the facility, the terms of such services, and related charges, including any charges for services not covered under Titles XVIII or XIX of the United States Social Security Act or not covered by the facility's basic per diem rate; 3. Is fully informed in summary form of the findings concerning the facility in federal Centers for Medicare & Medicaid Services surveys and investigations, if any; 4. Is fully informed by a physician, physician assistant, or nurse practitioner of his medical condition unless medically contraindicated as documented by a physician, physician assistant, or nurse practitioner in his medical record and is afforded the opportunity to participate in the planning of his medical treatment and to refuse to participate in experimental research; 5. Is transferred or discharged only for medical reasons, or for his welfare or that of other patients, or for nonpayment for his stay except as prohibited by Titles XVIII or XIX of the United States Social Security Act, and is given reasonable advance notice as provided in §32.1-138.1 to ensure orderly transfer or discharge, and such actions are documented in his medical record; 6. Is encouraged and assisted, throughout the period of his stay, to exercise his rights as a patient and as a citizen and to this end may voice grievances and recommend changes in policies and services to facility staff and to outside representatives of his choice, free from restraint, interference, coercion, discrimination, or reprisal; 7. May manage his personal financial affairs, or may have access to records of financial transactions made on his behalf at least once a month and is given at least a quarterly accounting of financial transactions made on his behalf should the facility accept his written delegation of this responsibility to the facility for any period of time in conformance with state law; 8. Is free from mental and physical abuse and free from chemical and, except in emergencies, physical restraints except as authorized in writing by a physician for a specified and limited period of time or when necessary to protect the patient from injury to himself or to others; 9. Is assured confidential treatment of his personal and medical records and may approve or refuse their release to any individual outside the facility, except in case of his transfer to another health care institution or as required by law or third-party payment contract; 10. Is treated with consideration, respect, and full recognition of his dignity and individuality, including privacy in treatment and in care for his personal needs; 11. Is not required to perform services for the facility that are not included for therapeutic purposes in his plan of care; 12. May associate and communicate privately with persons of his choice and send and receive his personal mail unopened, unless medically contraindicated as documented by his physician in his medical record; 13. May meet with and participate in activities of social, religious and community groups at his discretion, unless medically contraindicated as documented by his physician, physician assistant, or nurse practitioner in his medical record; 14. May retain and use his personal clothing and possessions as space permits unless to do so would infringe upon rights of other patients and unless medically contraindicated as documented by his physician, physician assistant, or nurse practitioner in his medical record; 15. If married, is assured privacy for visits by his or her
spouse and if both are inpatients in the facility, is permitted to share a room
with such spouse unless medically contraindicated as documented by the
attending physician, physician assistant, or nurse practitioner in the medical
record; 16. Is fully informed, as evidenced by the written acknowledgment of the resident or his legal representative, prior to or at the time of admission and during his stay, that he should exercise whatever due diligence he deems necessary with respect to information on any sexual offenders registered pursuant to Chapter 9 (§9.1-900 et seq.) of Title 9.1, including how to obtain such information. Upon request, the nursing home facility shall assist the resident, prospective resident, or the legal representative of the resident or prospective resident in accessing this information and provide the resident, prospective resident, or the legal representative of the resident or prospective resident with printed copies of the requested information; and 17. Is fully informed of the right of any patient to implement electronic monitoring in the room in which he resides, the right of any patient to consent or refuse to consent to electronic monitoring in any room in which he resides, and the options available to any patient in cases in which he refuses to consent to electronic monitoring in any room in which he resides, including transfer to another room, in accordance with regulations of the Board. B. All established policies and procedures regarding the
rights and responsibilities of patients shall be printed in at least 12-point
type and posted conspicuously in a public place in all nursing home facilities
required to be licensed under the provisions of Article 1 (§32.1-123 et seq.) C. The provisions of this section shall not be construed to restrict any right that any patient in residence has under law. D. Each facility shall provide appropriate staff training to implement each patient's rights included in subsection A hereof. E. All rights and responsibilities specified in subsection A hereof and §32.1-138.1 as they pertain to (i) a patient adjudicated incapacitated in accordance with state law, (ii) a patient who is found, by his physician, to be medically incapable of understanding these rights, or (iii) a patient who is unable to communicate with others shall devolve to such patient's guardian, responsible party as defined in regulation, next of kin, sponsoring agency or agencies, or representative payee, except when the facility itself is representative payee, selected pursuant to section 205(j) of Title II of the United States Social Security Act. The persons to whom such rights and responsibilities have devolved shall be deemed to have legal authority to act on the patient's behalf with respect to the matters specified in this section. F. Nothing in this section shall be construed to prescribe, regulate, or control the remedial care and treatment or nursing service provided to any patient in a nursing institution to which the provisions of § 32.1-128 are applicable. G. It shall be the responsibility of the Commissioner to
insure that the provisions of this section and the provisions of §32.1-138.1
are observed and implemented by nursing home facilities. Each nursing home
facility to which this section and §32.1-138.1 are applicable shall certify to
the Commissioner that it is in compliance with the provisions of this section
and the provisions of §32.1-138.1 as a condition to the issuance or renewal of
the license required by Article 1 (§32.1-123 et seq.) §32.1-138.1. Implementation of transfer and discharge policies. A. To implement and conform with the provisions of subdivision A 4 of §32.1-138, a facility may discharge the patient, or transfer the patient, including transfer within the facility, only: 1. If appropriate to meet that patient's documented medical needs; 2. If appropriate to safeguard that patient or one or more other patients from physical or emotional injury; 3. On account of nonpayment for his stay except as prohibited by Titles XVIII or XIX of the United States Social Security Act and the Virginia State Plan for Medical Assistance Services; or 4. With the informed voluntary consent of the patient, or if incapable of providing consent, with the informed voluntary consent of the patient's authorized decision maker pursuant to §54.1-2986 acting in the best interest of the patient, following reasonable advance written notice. B. Except in an emergency involving the patient's health or C. Except in an emergency involving the patient's health or D. Nothing in this section or in subdivision A 4 of §32.1-138
shall be construed to authorize or require conditions upon a transfer within a
facility that are more restrictive than E. No patient shall be transferred or discharged solely because he has implemented electronic monitoring in any room in which he resides or refuses to consent to electronic monitoring in any room in which he resides. 2. That the Board of Health shall promulgate regulations to implement the provisions of this act relating to electronic monitoring by patients in nursing homes and certified nursing facilities. |
