2015 -- H 6150 SUBSTITUTE A

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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. 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 that is related to the patient’s condition at the

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time of discharge. Such assistance may include, but is not limited to, assisting with basic

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activities of daily living (ADLs), instrumental activities of daily living (IADLs), or other tasks as

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determined to be appropriate by the discharging physician or other health care professional.

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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) "Patient" means a patient eighteen (18) years of age or older.

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     (7) "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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     23-17.27-2. 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 an opportunity to

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designate at least one caregiver under this chapter following the patient's entry into a hospital.

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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 a given timeframe, at the discretion of the attending

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physician or other health care professional, following the patient’s recovery of consciousness of

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capacity. The hospital shall inform the patient that the purpose of providing a caregiver’s identity

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is to include that caregiver and discharge planning and sharing of post-discharge care information

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or instruction.

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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 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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     (ii) 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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     (4) A patient or the patient's legal guardian may elect to change the patient's designated

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caregiver at any time, and the hospital must record this change in the patient’s medical record

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before the patient's discharge.

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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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     (d) In the event that the patient is a minor child, and the parents of the patient are

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divorced, the custodial parent shall have the authority to designate a caregiver. If the parents have

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joint custody of the patient, they shall jointly designate the caregiver.

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     23-17.27-3. 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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facility licensed by the state as soon as possible, in any event, upon issuance of a discharge order

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by the patient’s attending physician or other health care professional. In the event the hospital is

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unable to contact the designated caregiver, the lack of contact shall not interfere with, delay, or

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otherwise affect the medical care provided to the patient, or an appropriate discharge of the

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patient. The hospital shall promptly document the attempt in the patient’s medical record.

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     23-17.27-4. Instruction to Designated Caregiver. – (a) As soon as possible and prior to

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a patient’s discharge from a hospital, the hospital shall consult with the designated caregiver

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along with the patient regarding the caregiver’s capabilities and limitations and issue a discharge

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plan that describes a patient’s after-care needs at his or her residence.

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     The consultation session will include an assessment of the caregiver’s capability to

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provide after care and any limitations the caregiver foresees in providing after care. Each hospital

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will have the discretion to determine which hospital staff are best qualified to conduct the

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caregiver assessment. If, upon assessment, the hospital determines a caregiver may have

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difficulty supplying the needed care safely, the discharge plan may be adjusted accordingly, and

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alternate care arrangements may be made in consultation with the caregiver.

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     (b) The consultation and issuance of a discharge plan shall occur on a schedule that takes

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into consideration the severity of the patient’s condition, the setting in which care is to be

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delivered, and the urgency of the need for caregiver services. In the event the hospital is unable to

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contact the designated caregiver, the lack of contact shall not interfere with, delay, or otherwise

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affect the medical care provided to the patient, or an appropriate discharge of the patient. The

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hospital shall promptly document the attempt in the patient’s medical record.

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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 recommended by the patient's physician or other

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health care professional, 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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     (c) The hospital issuing the discharge plan must offer to provide caregivers with

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instruction in all after-care tasks described in the discharge plan. Any training or instructions

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provided to a caregiver shall be provided, to the extent possible, in non-technical language and in

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the caregiver’s native language.

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     (1) At minimum, such instruction shall include:

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

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individual with whom the hospital has a contractual relationship authorized to perform the after-

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care task;

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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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     (d) 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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     (e) Nothing in this chapter shall delay the discharge of a patient, or the transfer of a

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patient from a hospital to another facility.

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     23-17.27-5. Non-Interference with Powers of Existing Health Care Directives. – (a)

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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 chapter 4.10 of title 23 (health care power of attorney), or

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§ 23-4.11-3.1 (medical orders for life sustaining treatment).

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     (b) A patient may designate a caregiver in an advance directive.

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     23-17.27-6. Caregiver reimbursement. – (a) A caregiver shall not be reimbursed by any

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government or commercial payer for after-care assistance that is provided pursuant to this

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chapter, with the sole exception that this chapter shall not supersede the applicability of wage

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replacement benefits paid to workers under Rhode Island’s temporary disability insurance

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program, pursuant to § 28-41-35.

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     (b) Nothing in this chapter shall be construed to impact, impede, or otherwise disrupt or

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reduce the reimbursement obligations of an insurance company, health service corporation,

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hospital service corporation medical service corporation, health maintenance organization or any

 

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other entity issuing health benefits plans.

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

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create a private right of action against a hospital or any of its directors, trustees, officers,

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employees or agents or any contractors with whom the hospital has a contractual relationship.

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     (b) A hospital, a hospital employee, or any consultants or contractors with whom a

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hospital has a contractual relationship shall not be held liable, in any way, for the services

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rendered or not rendered by the caregiver to the patient at the patient’s residence.

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     23-17.27-8. Severability. – If any provision of this chapter or the application of any

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provision to any person or circumstance 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 on March 1, 2016.

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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, and to provide caregivers with proper

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training.

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     This act would take effect on March 1, 2016.

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