Regular Session 2015-2016 House Bill 1329 P.N. 2967

SENATE AMENDED

PRIOR PRINTER'S NOS. 1796, 1883

PRINTER'S NO. 2967

THE GENERAL ASSEMBLY OF PENNSYLVANIA

HOUSE BILL

No.

1329

Session of

2015

INTRODUCED BY ENGLISH, HENNESSEY, SAMUELSON, PICKETT, FREEMAN,

V. BROWN, KOTIK, KILLION, KINSEY, READSHAW, TOEPEL, DAVIDSON,

SAYLOR, SCHLOSSBERG, MILLARD, RAVENSTAHL, QUIGLEY, COHEN,

KORTZ, TALLMAN, MURT, MAHER, MUSTIO, GERGELY, D. COSTA,

M. DALEY, MENTZER, HARHART, SIMS, SCHEMEL, DAVIS, DEAN,

A. HARRIS, SCHREIBER AND BULLOCK, JUNE 12, 2015

AS REPORTED FROM COMMITTEE ON AGING AND OLDER ADULT SERVICES,

HOUSE OF REPRESENTATIVES, AS AMENDED, JUNE 24, 2015

AN ACT

Requiring certain hospitals to allow patients an opportunity to

designate caregivers in patients' medical records and

imposing duties on hospitals.

The General Assembly of the Commonwealth of Pennsylvania

hereby enacts as follows:

Section 1. Short title.

This act shall be known as the Caregiver Advise, Record and

Enable Act.

Section 2. Definitions.

The following words and phrases when used in this act shall

have the meanings given to them in this section unless the

context clearly indicates otherwise:

"After-care assistance." Any assistance provided by a lay

caregiver to a patient following the patient's discharge from a

hospital and that is related to the patient's condition at the

time of discharge, including, but not limited to, assisting with

basic activities of daily living, instrumental activities of

daily living and any other tasks as determined to be appropriate

by the discharging physician or other health care professional

licensed pursuant to 28 Pa. Code Ch. 105 (relating to admission

and discharge).

"Discharge." A patient's exit or release from a hospital to

the patient's residence following medical care or treatment

rendered to the patient following an inpatient admission.

"Entry." A patient's admission into a hospital for the

purposes of receiving inpatient medical care.

"Hospital." A general acute care hospital as defined and

licensed under Title 28 of the Pennsylvania Code (relating to

health and safety).

"Lay caregiver." An individual with a significant

relationship to a patient and who:

(1) is designated and accepts the role as a lay

caregiver by the patient pursuant to this act; and

(2) provides after-care assistance to the patient living

in the patient's residence.

"Residence." The dwelling that a patient considers to be the

patient's home. The term includes the residence of a patient's

designated lay caregiver. The term shall not include a

rehabilitation facility, hospital, nursing home, personal care

home, assisted living facility or group home licensed by the

Department of Health.

Section 3. Caregiver designation and consent.

(a) General rule.--A hospital shall provide each patient or,

if applicable, the patient's legal guardian an opportunity to

designate at least one lay caregiver following the patient's

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entry into a hospital and, prior to the patient's discharge to

the residence, in a time frame that is consistent with the

discharge planning process provided by regulation. The hospital

shall promptly document the request in the patient's medical

record.

(b) Unconscious and incapacitated patients.--In the event

that the patient is unconscious or otherwise incapacitated upon

entry into a hospital, the hospital shall provide the patient or

the patient's legal guardian with an opportunity to designate a

lay caregiver as soon as possible following the patient's

recovery of consciousness or capacity. The hospital shall

promptly document the designation in the patient's medical

records.

patient or the patient's legal guardian declines to designate a

lay caregiver pursuant to this act, the hospital shall promptly

document the decision in the patient's medical record.

(d) Designation of lay caregivers.--In the event that IF the

patient or the patient's legal guardian designates an individual

as lay caregiver under this act:

(1) The hospital shall promptly request the written

consent of the patient or the patient's legal guardian to

release medical information to the patient's designated lay

caregiver following the hospital's established procedures for

releasing personal health information and in compliance with

all Federal and State laws, including the Health Insurance

Portability and Accountability Act of 1996 (Public Law 104-

191, 110 Stat. 1936) and related regulations.

(2) If the patient or the patient's legal guardian

declines to consent to release medical information to the

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patient's designated lay caregiver, the hospital is not

required to provide notice to the lay caregiver or provide

MEDICAL information contained in the patient's discharge

plan.

(3) The hospital shall record the patient's designation

of A lay caregiver, the relationship of the designated lay

caregiver to the patient and the name, telephone number and

address of the patient's designated lay caregiver in the

patient's medical record.

(e) Change of lay caregiver.--A patient or the patient's

legal guardian may elect to change the patient's lay caregiver

at any time, and the hospital shall record the change in the

patient's medical record before PRIOR TO the patient's

discharge.

(f) Construction.--This section shall not be construed to

require a patient or patient's legal guardian to designate an

individual as a lay caregiver.

(g) After-care assistance.--A designation of a lay caregiver

by a patient or a patient's legal guardian does not obligate the

designated individual to perform any after-care assistance for

the patient.

(h) Minor children.--In the event that the patient is a

minor child and the parents of the patient are divorced, the

parent with legal custody of the patient shall have the

authority to designate a lay caregiver. If the parents have

shared legal custody of the patient, they shall jointly

designate the lay caregiver.

Section 4. Notice requirements.

(a) Duty to hospital.--A hospital shall notify a patient's

designated lay caregiver of any discharge order for the patient,

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the patient's actual discharge or the patient's transfer to

another facility as soon as possible.

(b) Documentation.--The hospital shall promptly document the

attempt NOTIFICATION in the patient's medical record.

Section 5. Hospital discharge plan.

(a) Duty to issue.--

(1) As soon as possible prior to a patient's discharge

from a hospital to the residence, the hospital shall consult

with the designated lay caregiver and issue a discharge plan

that describes the patient's after-care assistance needs, if

any, at the residence.

(2) The consultation and issuance of a discharge plan

shall occur on a schedule that takes into consideration the

severity of the patient's condition, the setting in which

care is to be delivered and the urgency of the need for lay

caregiver services.

(3) In the event IF the hospital is unable to contact

the designated lay caregiver, the lack of contact shall not

interfere with, delay or otherwise affect the medical care

provided to the patient or an appropriate discharge of the

patient.

(4) At a minimum, the discharge plan shall include:

(i) The name and contact information of the lay

caregiver designated under this act.

(ii) A description of all after-care assistance

tasks necessary to maintain the patient's ability to

reside at home.

(iii) Contact information for any health care,

community resources, long-term care services and supports

SUPPORT SERVICES necessary to successfully carry out the

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patient's discharge plan and contact information for a

hospital employee who can respond to questions about the

discharge plan after the instruction provided pursuant to

subsection (b).

(b) Instructions for lay caregivers.--

(1) The hospital issuing the discharge plan shall

provide lay caregivers with instructions in all after-care

tasks described in the discharge plan. Training and

instructions for lay caregivers may be conducted in person or

through video technology at the discretion of the lay

caregiver. Any training or instructions provided to a lay

caregiver shall be provided in nontechnical language, to the

extent possible.

(2) At minimum, such instruction shall include:

(i) A live or recorded demonstration of the tasks

performed by an individual designated by the hospital,

who is authorized to perform the after-care task, TASK

and is able to perform the demonstration in a culturally

competent manner and in accordance with the hospital's

requirements to provide language access services under

Federal and State law.

(ii) An opportunity for the lay caregiver and

patient to ask questions about the after-care assistance

task.

(iii) Answers to the lay caregiver's questions

provided in a culturally competent manner and in

accordance with the hospital's requirements to provide

language access services under Federal and State law.

Section 6. Advanced directives.

(a) General rule.--A patient may designate a lay caregiver

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in an advanced directive.

(b) Construction.--Nothing in this act shall be construed to

interfere with the rights of an agent operating under a valid

advanced directive pursuant to the provisions under 20 Pa.C.S.

Ch. 54 (relating to health care).

Section 7. Private rights of action.

(a) General rule.--A hospital, a hospital employee or any

consultants or contractors with whom a hospital has a

contractual relationship shall not be held liable, in any way,

for the services rendered or not rendered by the lay caregiver

to the patient at the residence.

(b) Construction.--Nothing in this act shall be construed:

(1) To TO create a private right of action against a

hospital, a hospital employee or any consultants or

contractors with whom a hospital has a contractual

relationship. OR REQUIRE ANY COMMERCIAL HEALTH INSURANCE

POLICY OR GOVERNMENT PROGRAM TO PROVIDE REIMBURSEMENT FOR

AFTER-CARE ASSISTANCE PROVIDED BY A LAY CAREGIVER.

(2) To obviate the obligation of an insurance company,

professional health service corporation, hospital plan

corporation, general medical service corporation, health

maintenance organization or any other entity issuing health

benefit plans to provide coverage under a health benefits

plan.

(1) No lay caregiver may be reimbursed by a government

or commercial payer for after-care assistance that is

provided pursuant to this act.

(2) Nothing in this act shall be construed to impact,

impede or otherwise disrupt or reduce the reimbursement

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obligations of an insurance company, professional health

service corporation, hospital plan corporation, general

medical service corporation, health maintenance organization

or any other entity issuing a health benefits plan, including

any government waiver program already providing reimbursement

to a lay caregiver pursuant to this act.

Section 8. Delay of discharge.

Nothing in this act shall be construed to delay the discharge

of a patient or the transfer of a patient from a hospital to

another facility.

Section 9. Joint State Government Commission LEGISLATIVE BUDGET

AND FINANCE COMMITTEE study.

(a) Duty to conduct.--No later than three years after the

effective date of this section, the Joint State Government

Commission LEGISLATIVE BUDGET AND FINANCE COMMITTEE shall

conduct a study regarding the impact of this act on certain

patient outcomes, including, but not limited to, hospital

readmissions.

(b) Input to be solicited.--In conducting the study, the

Joint State Government Commission LEGISLATIVE BUDGET AND FINANCE

COMMITTEE shall solicit input from all key stakeholders,

including, but not limited to, patients, lay caregivers,

physicians, nurses and hospitals., OTHER HEALTH CARE

PROFESSIONALS, HOSPITALS AND OTHER HEALTH CARE FACILITIES.

Commission LEGISLATIVE BUDGET AND FINANCE COMMITTEE shall submit

its findings to the General Assembly no later than five years

after the effective date of this section.

Section 10. Effective date.

This act shall take effect in 12 months.

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