2015 -- H 6150

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LC002555

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2015

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A N   A C T

RELATING TO HEALTH AND SAFETY - CAREGIVER ADVISE, RECORD AND ENABLE

ACT

     

     Introduced By: Representatives Naughton, Ajello, McNamara, Ackerman, and Fogarty

     Date Introduced: April 30, 2015

     Referred To: House Health, Education & Welfare

     It is enacted by the General Assembly as follows:

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     SECTION 1. Title 23 of the General Laws entitled "HEALTH AND SAFETY" is hereby

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amended by adding thereto the following chapter:

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CHAPTER 17.27

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CAREGIVER ADVISE, RECORD AND ENABLE ACT

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     23-17.27-1. Legislative findings and purpose. – An estimated 148,000 Rhode Islanders

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provide varying degrees of unreimbursed care to adults with limitations in daily activities. The

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total value of the unpaid care provided to individuals in need of long-term services and supports

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amounts to an estimated $1.9 billion every year, based on 2009 data. Caregivers are often

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members of the individual's immediate family, but friends and other community members also

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serve as caregivers. While most caregivers are asked to assist an individual with basic activities

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of daily living, such as mobility, eating, and dressing, many are expected to perform complex

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tasks on a daily basis such as administering multiple medications, providing wound care, and

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operating medical equipment.

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     Despite the vast importance of caregivers in the individual's day-to-day care, many

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caregivers find that they are often left out of discussions involving a patient's care while in the

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hospital and, upon the patient's discharge, receive little to no instruction on the tasks they are

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expected to perform. The federal Centers for Medicare & Medicaid Services (CMS) estimates

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that $17 billion in Medicare funds or spent each year on unnecessary hospital readmissions.

 

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Additionally, hospitals desire to avoid the imposition of new readmission penalties under the

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federal Patient Protection and Affordable Care Act (ACA).

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     In order to successfully address the challenges of a surging population of older adults and

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others living with chronic conditions and who have significant needs for long-term services and

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supports, the purpose of the state must be to develop methods to enable caregivers to continue to

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support their loved ones at home and in the community, and avoid costly hospital readmissions.

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Therefore, it is the intent that this chapter enables caregivers to provide competent post-hospital

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care to their family and other loved ones, at minimal cost to the taxpayers of this state.

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     23-17.27-2. Definitions. – As used in this chapter:

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     (1) "After-care" means any assistance provided by a caregiver to a patient under this

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chapter after the patient's discharge from a hospital. Such assistance may include, but is not

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limited to, assisting with basic activities of daily living (ADLs), instrumental activities of daily

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living (IADLs), or carrying out medical/nursing tasks, such as managing wound care, assisting in

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administering medications, and operating medical equipment.

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     (2) "Caregiver" means any individual duly designated as a caregiver by a patient under

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this chapter who provides after-care assistance to a patient living in his or her residence. A

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designated caregiver may include, but is not limited to, a relative, partner, friend, or neighbor who

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has a significant relationship with the patient.

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     (3) "Discharge" means a patient's exit or release from a hospital to the patient's residence

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following an inpatient admission.

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     (4) "Entry" means a patient's admission into a hospital for the purposes of medical care.

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     (5) "Hospital" means a facility licensed under Rhode Island statute.

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     (6) "Residence" means a dwelling that the patient considers to be his or her home. A

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"residence" for the purposes of this chapter shall not include any rehabilitation facility, hospital,

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nursing home, assisted living facility, or group home licensed by Rhode Island.

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     23-17.27-3. Caregiver designation. – (a) Any hospital licensed pursuant to this title

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shall provide each patient or, if applicable, the patient's legal guardian with at least one

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opportunity to designate at least one caregiver under this chapter, no later than twenty-four (24)

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hours following the patient's entry into a hospital and prior to the patient's discharge or transfer to

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another facility.

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     (1) In the event that the patient is unconscious or otherwise incapacitated upon his or her

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entry into a hospital, the hospital shall provide such patient or his/her legal guardian with an

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opportunity to designate a caregiver within twenty-four (24) hours following the patient’s

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recovery of his or her consciousness of capacity.

 

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     (2) In the event that the patient or the patient’s legal guardian declines to designate a

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caregiver under this chapter, the hospital shall promptly document this in the patient’s medical

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record.

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     (3) In the event that the patient or the patient’s legal guardian designates an individual as

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a caregiver under this chapter:

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     (i) The hospital shall promptly request the written consent of the patient or the patient’s

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legal guardian to release medical information to the patient’s designated caregiver following the

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hospital’s established procedures for releasing personal health information and in compliance

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with all federal and state laws.

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     (A) If the patient or the patient’s legal guardian declines to consent to release medical

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information to the patient’s designated caregiver the hospital is not required to provide notice to

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the caregiver under § 23-17.27-4 or provide information contained in the patient’s discharge plan

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under § 23-17.27-5.

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     (ii) The hospital shall record the patient’s designation of the caregiver, the relationship of

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the designated caregiver to the patient, and the name, telephone number, and the address of the

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patient’s designated caregiver in the patient’s medical record.

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     (4) A patient may elect to change his or her designated caregiver at any time, and the

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hospital must record this change in the patient’s medical record within twenty-four (24) hours.

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     (b) A designation of a caregiver by a patient or patient’s legal guardian under this section

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does not obligate any individual to perform any after-care tasks for any patient.

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     (c) This section shall not be construed to require a patient or a patient’s legal guardian to

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designate any individual as a caregiver as defined by this chapter.

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     23-17.27-4. Notice to Designated Caregiver. – (a) Any hospital licensed pursuant to this

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title shall notify the patient’s designated caregiver of the patient’s discharge or transfer to another

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hospital or facility licensed by the state as soon as possible, which may be after the patient’s

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physician issues a discharge order, and not later than four (4) hours prior to the patient’s actual

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discharge or transfer to such facility.

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     23-17.27-5. Instruction to Designated Caregiver. – (a) As soon as possible and not later

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than twenty than twenty-four (24) hours prior to a patient’s discharge from a hospital, the hospital

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shall consult with the designated caregiver along with the patient regarding the caregiver’s

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capabilities and limitations and issue a discharge plan that describes a patient’s after-care needs at

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his or her residence.

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     (1) At minimum, a discharge plan shall include:

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     (i) The name and contact information of the caregiver designated under this chapter;

 

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     (ii) A description of all after-care tasks necessary to maintain the patient’s ability to

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reside home, taking into account the capabilities and limitations of the caregiver;

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     (iii) Contact information for any health care, community resources, and long-term

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services and support necessary to successfully carry out the patient’s discharge plan.

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     (b) The hospital issuing the discharge plan must provide caregivers with instruction in all

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after-care tasks described in the discharge plan.

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     (1) At minimum, such instruction shall include:

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     (i) A live demonstration of the tasks performed by the hospital employee or individual

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with whom the hospital has a contractual relationship authorized to perform the after-care task,

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provided in a culturally competent manner and in accordance with the hospital’s requirements to

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provide language access under state and federal law;

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     (ii) An opportunity for the caregiver and patient to ask questions about the after-care

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tasks; and

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     (iii) Answers to the caregiver’s and the patient’s questions provided in a culturally

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competent manner and in accordance with the hospital’s requirements to provide language access

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services under state and federal law.

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     (2) Any instruction required under this chapter shall be documented in the patient’s

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medical record, including, at minimum, the date, time, and contents of the instruction.

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     (c) The Rhode Island department of health is authorized to promulgate regulations to

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implement the provisions of this chapter including, but not limited to, regulations to further define

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the content and scope of any instruction provided to caregivers under this chapter.

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     23-17.27-6. Non-Interference with Powers of Existing Health Care Directives. –

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Nothing in this chapter shall be construed to interfere with the rights of an agent operating under

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a valid health care directive pursuant to Rhode Island general law.

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     23-17.27-7. Limitations of Actions. – Nothing in this chapter shall be construed to create

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a private right of action against a hospital, a hospital employee, or an individual, with whom a

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hospital has a contractual relationship, or to otherwise supersede or replace existing rights or

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remedies under any other provision of law.

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     23-17.27-8. Penalties. – Whoever violates the provision of this chapter shall, upon

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conviction, be punished by imprisonment for not more than one year or by a fine of not more than

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five thousand dollars ($5,000).

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     23-17.27-9. Severability. – If any provision of this chapter or the application of any

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provision to any person or circumstances is held invalid or unconstitutional, the invalidity or

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unconstitutionality shall not affect other provisions or applications of this chapter which can be

 

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given effect without the invalid or unconstitutional provision or application, and to this end the

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provisions of this chapter are declared to be severable.

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     SECTION 2. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO HEALTH AND SAFETY - CAREGIVER ADVISE, RECORD AND ENABLE

ACT

***

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     This act would create the "Caregiver Advise, Record and Enable Act" to provide support

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and assistance to individuals with post hospital care.

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     This act would take effect upon passage.

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