2025 -- H 5170

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LC000587

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2025

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A N   A C T

RELATING TO HEALTH AND SAFETY -- RIGHTS OF NURSING HOME PATIENTS

     Introduced By: Representatives Donovan, McNamara, Carson, Speakman, Fogarty,
Spears, Boylan, Potter, Cruz, and Morales

     Date Introduced: January 24, 2025

     Referred To: House Health & Human Services

     It is enacted by the General Assembly as follows:

     SECTION 1. Section 23-17.5-30 of the General Laws in Chapter 23-17.5 entitled "Rights

of Nursing Home Patients" is hereby amended to read as follows:

     23-17.5-30. Family councils.

     (a) For the purposes of this section “family council” means an organized group of the

family members, friends or representatives of facility residents who may meet in private without

the presence of facility staff.

     (b) The role of the family council shall be to address issues affecting residents generally at

the facility, not to pursue individual grievances. The family council shall not be entitled to obtain

information about individual residents or staff members, or any other information deemed

confidential under state or federal law. Notwithstanding the foregoing:

     (1) A facility shall provide the family council with the names, email addresses, and other

contact information for each resident’s representatives, family members, or other individuals

designated by the resident if the person has provided written consent specifying the contact

information that may be shared with the family council.

     (2) The facility shall inform the identified family members, friends, and representatives of

their right to have their contact information shared with the family council and their right to consent

or withhold consent to have their contact information shared with the family council pursuant to

subsection (b)(1) of this section.

     (c) No licensed nursing facility may prohibit the formation of a family council. When

requested by a member of a resident’s family or a resident’s representative, a family council shall

be allowed to meet in a common meeting room of the nursing facility at least once a month during

mutually agreed upon hours.

     (d) Upon the admission of a resident, the nursing facility shall inform the resident and the

resident’s family members, in writing, of their right to form a family council, or if a family council

already exists, of the date, time and location of scheduled meetings.

     (1) If a facility has a family council, the facility shall inform the resident and the resident’s

representatives, family members, or other individuals designated by the resident or identified

during the admission process of the existence of the family council. The facility shall provide the

resident and those family members, friends, and resident representatives with the name and contact

information of the family council representative, as designated by the family council, in writing,

prior to or within five (5) business days after the resident’s admission or the resident’s

representative, family member, or other individual is designated or identified. When family council

meeting information is provided by the family council, the facility shall include notice of family

council meetings in routine communications to those family members, friends, and resident

representatives. The notice shall include the time, place, and date of meetings, and the name and

contact information of the family council representative, as designated by the family council.

     (2) If a facility does not have a family council, the facility shall provide, upon admission

of a new resident, written information to the resident’s family members, friends, or resident

representatives identified during the admission process of their right to form a family council.

     (3) The family council shall not allow a family member or friend of a resident to participate

in the family council against the objection of the resident.

     (e) The nursing facility administration shall notify the state long-term care ombudsman of

the existence or planned formation of a family council at that facility. With the consent of the

designated representative(s) of the family council, the facility shall share the name and contact

information of the designated representative(s) of the family council with the long-term care

ombudsman program.

     (f) The family council may exclude members only for good cause, subject to appeal by the

excluded party to the state long-term care ombudsman. No member shall be excluded on the basis

of race or color, religion, gender, sexual orientation, disability, age or country of ancestral origin.

     (g) A facility shall provide its family council with adequate space in a prominent posting

area for the display of information pertaining to the family council.

     (h) Staff or visitors may attend family council meetings at the council’s invitation.

     (i) The nursing facility shall provide a designated staff person who, at the request of the

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council, shall be responsible for providing assistance to the family council and for responding to

recommendations and requests made by the family council.

     (j) The nursing facility shall consider the recommendations of the family council

concerning issues and policies affecting resident care and life at the nursing facility. If a family

council submits written requests, concerns or recommendations, the facility shall consider those

requests, concerns or recommendations, and respond, in writing, regarding any action or inaction

taken in response within five (5) business days, and shall detail its rationale for that response.

     (k) A violation of the provisions of this section will constitute a violation of the rights of

nursing home residents.

     SECTION 2. Chapter 23-17.5 of the General Laws entitled "Rights of Nursing Home

Patients" is hereby amended by adding thereto the following section:

     23-17.5-38. Facility admission waiting lists.

     (a) A nursing home which receives payment from the state for rendering care to indigent

persons shall:

     (1) Be prohibited from discriminating against indigent persons who apply for admission to

such facility on the basis of source of payment. Except as otherwise provided by law, all applicants

for admission to such facility shall be admitted in the order in which such applicants apply for

admission. Each nursing home shall:

     (i) Provide a receipt to each applicant for admission to its facility who requests placement

on a waiting list stating the date and time of such request; and

     (ii) Maintain a dated list of such applications which shall be available at all times to any

applicant, their bona fide representative, authorized personnel from the department of health and

human services, the long-term care ombudsman, and such other state agencies or other bodies

established by state statute whose statutory duties necessitate access to such lists.

     (2)(i) If a nursing home desires to remove the name of an applicant who is unresponsive to

facility telephone calls and letters from its waiting list, no sooner than ninety (90) days after initial

placement of the person's name on the waiting list, inquire by letter to such applicant and any one

person if designated by such applicant whether the applicant desires continuation of their name on

the waiting list. If the applicant does not respond and an additional thirty (30) days pass, the facility

may remove such applicant's name from its waiting list;

     (ii) A nursing home may annually send a waiting list placement continuation letter to all

persons on the waiting list for at least ninety (90) days to inquire as to whether such person desires

continuation of their name on the waiting list; provided that, such letter shall also be sent to any

one person if designated by such applicant. If such person does not respond and at least thirty (30)

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days pass, the facility may remove the person's name from its waiting list. Indigent persons shall

be placed on any waiting list for admission to a facility and shall be admitted to the facility as

vacancies become available, in the same manner as self-pay applicants, except as provided in

subsections (e) and (f) of this section;

     (3) Post in a conspicuous place a notice informing applicants for admission that the facility

is prohibited by statute from discriminating against indigent applicants for admission on the basis

of source of payment. Such notice shall advise applicants for admission of the remedies available

under this section and shall list the name, address and telephone number of the state long-term care

ombudsman;

     (4) Be prohibited from requiring that an indigent person pay any sum of money or furnish

any other consideration including, but not limited to, the furnishing of an agreement by the relative,

conservator or other responsible party of an indigent person which obligates such party to pay for

care rendered to an indigent person as a condition for admission of such indigent person; and

     (5) Record in the patient roster, or in a separate roster maintained for this purpose, the

number of patients who are Medicare, Medicaid and private pay patients on each day. Such

numbers shall be recorded daily and made available, upon request, to the state long-term care

ombudsman.

     (b) Upon the receipt of a complaint concerning a violation of this section, the department

of health shall conduct an investigation into such complaint.

     (c) The department of health is authorized to decrease the daily reimbursement rate to a

nursing home for one year for a violation of this section which occurred during the twelve (12)

month period covered by the cost report upon which the per diem rate is calculated. The per diem

rate shall be reduced by one-quarter (1/4) of one percent for an initial violation of this section and

one percent for each additional violation.

     (d) Prior to imposing any sanction, the department of health shall notify the nursing home

of the alleged violation and the accompanying sanction, and shall permit such facility to request an

administrative hearing. A facility shall request such hearing within fifteen (15) days of receipt of

the notice of violation from the department of health. The department shall stay the imposition of

any sanction pending the outcome of the administrative hearing.

     (e) A nursing home with a number of self-pay residents equal to or less than thirty percent

(30%) of its total number of residents shall not be required to admit an indigent person on a waiting

list for admission when a vacancy becomes available during the subsequent six (6) months,

provided:

     (1) No bed may be held open for more than thirty (30) days; and

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     (2) The nursing home notifies the department of health and the state long-term care

ombudsman on the date on which such six (6) month period of waiting list exemption began and

thereafter on a quarterly basis if the conditions for exemption still apply.

     (f) A nursing home shall not be required to admit an indigent person on a waiting list for

admission when a vacancy becomes available if the vacancy is in a private room.

     (g) Notwithstanding the provisions of this section, a nursing home shall, without regard to

the order of its waiting list, admit an applicant who:

     (1) Seeks to transfer from a nursing home that is closing; or

     (2)(i) Seeks to transfer from a nursing home in which the applicant was placed following

the closure of the nursing home where such applicant previously resided or, in the case of a nursing

home placed in receivership, the anticipated closure of the nursing home where such applicant

previously resided; provided that, the transfer occurs not later than sixty (60) days following the

date that such applicant was transferred from the nursing home where they previously resided and

except when the nursing home that is closing transferred the resident due to an emergency, the

applicant submitted an application to the nursing home to which they seek admission at the time of

the applicant's transfer from the nursing home where they previously resided;

     (ii) A nursing home that qualifies for a waiting list exemption pursuant to subsections (e)

or (f) of this section shall not be required to admit an indigent person under this subsection except

when the resident is being transferred from a nursing home that is closing due to an emergency.

     (h) No nursing home shall be required to admit an applicant pursuant to the provisions of

this section if the nursing home has determined that:

     (1) The applicant does not have a payor source because the applicant has been denied

Medicaid eligibility or the applicant has failed to pay a nursing home that is closing for the three

(3) months preceding the date of the application for admittance and has no pending application for

Medicaid;

     (2) The applicant is subject to a Medicaid penalty period; or

     (3) The applicant does not require nursing home level of care as determined in accordance

with applicable state and federal requirements.

     SECTION 3. 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 -- RIGHTS OF NURSING HOME PATIENTS

***

     This act would support the establishment and role of independent family councils in

nursing facilities. This act would further prevent discrimination against nursing home residents,

where the method of payment is Medicaid, by making the waiting list process transparent, and

requiring facilities with more than thirty percent (30%) self-pay residents to admit applicants on a

first-come-first-served basis for non-private rooms.

     This act would take effect upon passage.

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