Second Regular Session Seventy-third General Assembly STATE OF COLORADO REVISED This Version Includes All Amendments Adopted on Second Reading in the Second House LLS NO. 22-0583.01 Kristen Forrestal x4217 SENATE BILL 22-053 Senate Committees House Committees State, Veterans, & Military Affairs State, Civic, Military, & Veterans Affairs Appropriations Appropriations A BILL FOR AN ACT C ONCERNING VISITATION RIGHTS AT HEALTH -CARE FACILITIES, AND, 101 IN CONNECTION THEREWITH , MAKING AN APPROPRIATION .102 Bill Summary (Note: This summary applies to this bill as introduced and does not reflect any amendments that may be subsequently adopted. If this bill passes third reading in the house of introduction, a bill summary that applies to the reengrossed version of this bill will be available at http://leg.colorado.gov .) The bill specifies that a patient admitted to a hospital for inpatient care and a resident of a nursing care facility or assisted living residence may have at least one visitor of the patient's or resident's choosing during the stay or residency. A hospital, a nursing care facility, and an assisted living residence (collectively referred to as "health-care facility") must have written policies and procedures regarding the visitation rights of HOUSE Amended 2nd Reading May 10, 2022 SENATE 3rd Reading Unamended March 29, 2022 SENATE Amended 2nd Reading March 25, 2022 SENATE SPONSORSHIP Sonnenberg, Cooke, Donovan, Holbert, Kirkmeyer, Lundeen, Scott, Simpson, Smallwood, Woodward HOUSE SPONSORSHIP McLachlan and Geitner, Shading denotes HOUSE amendment. Double underlining denotes SENATE amendment. Capital letters or bold & italic numbers indicate new material to be added to existing statute. Dashes through the words indicate deletions from existing statute. patients and residents, including policies and procedures setting forth any clinically necessary or reasonable restriction or limitation that the health-care facility may need to place on patient and resident visitation rights and the reasons for the restriction or limitation. The bill prohibits a health-care facility from adopting policies or procedures that prohibit visitation of a patient or resident if the sole reason for the prohibition is to reduce the risk of transmission of a pandemic disease, but a health-care facility may impose specified restrictions and limitations for visitors to reduce the risk of transmission of the pandemic disease. Be it enacted by the General Assembly of the State of Colorado:1 SECTION 1. In Colorado Revised Statutes, 25-1-120, amend2 (1)(b) as follows:3 25-1-120. Nursing facilities - rights of patients. (1) The4 department shall require all skilled nursing facilities and intermediate care5 facilities to adopt and make public a statement of the rights and6 responsibilities of the patients who are receiving treatment in such7 facilities and to treat their patients in accordance with the provisions of8 said statement. The statement shall ensure each patient the following:9 (b) The right to have private and unrestricted communications10 with any person of his THE PATIENT'S choice, EXCEPT AS SPECIFIED IN11 SECTION 25-3-125 (2) AND (3);12 SECTION 2. In Colorado Revised Statutes, recreate and13 reenact, with amendments, 25-3-125 as follows:14 25-3-125. Visitation rights - hospital patients - residents in15 nursing care facilities or assisted living residences - limitations during16 a pandemic - definitions - short title. (1) T HE SHORT TITLE OF THIS17 SECTION IS THE "NO PATIENT OR RESIDENT LEFT ALONE ACT".18 (2) (a) SUBJECT TO THE RESTRICTIONS AND LIMITATIONS FOR19 SKILLED NURSING FACILITY AND NURSING FACILITY RESIDENTS' VISITATION20 053-2- RIGHTS SPECIFIED IN 42 U.S.C. 1396r (c)(3)(C); 42 U.S.C. 1395i (c)(3)(C);1 42 CFR 483.10 (a), (b), AND (f); THE RIGHTS FOR ASSISTED LIVING2 RESIDENTS SPECIFIED IN RULE PURSUANT TO SECTION 25-27-104; THE3 RESTRICTIONS AND LIMITATIONS SPECIFIED BY A HEALTH-CARE FACILITY4 PURSUANT TO SUBSECTION (3) OF THIS SECTION; RESTRICTIONS AND5 LIMITATIONS SPECIFIED IN STATE OR LOCAL PUBLIC HEALTH ORDERS; AND6 THE COMMUNICATIONS EXCEPTION SPECIFIED IN SECTION 25-1-120, IN7 ADDITION TO HOSPITAL PATIENT VISITATION RIGHTS IN 42 CFR 482.13 (h),8 A PATIENT OR RESIDENT OF A HEALTH-CARE FACILITY MAY HAVE AT LEAST9 ONE VISITOR OF THE PATIENT'S OR RESIDENT'S CHOOSING DURING THE10 PATIENT'S STAY OR RESIDENCY AT THE HEALTH -CARE FACILITY,11 INCLUDING:12 (I) A VISITOR TO PROVIDE A COMPASSIONATE CARE VISIT TO13 ALLEVIATE THE PATIENT'S OR RESIDENT'S PHYSICAL OR MENTAL DISTRESS;14 (II) A VISITOR OR SUPPORT PERSON DESIGNATED PURSUANT TO15 SUBSECTION (2)(b) OF THIS SECTION FOR A PATIENT OR RESIDENT WITH A16 DISABILITY; AND17 (III) F OR A PATIENT WHO IS UNDER EIGHTEEN YEARS OF AGE , THE18 PARENT OR LEGAL GUARDIAN OF , OR THE PERSON STANDING IN LOCO19 PARENTIS TO, THE PATIENT.20 (b) (I) A PATIENT OR RESIDENT OF A HEALTH-CARE FACILITY MAY21 DESIGNATE, ORALLY OR IN WRITING, A SUPPORT PERSON WHO SUPPORTS22 THE PATIENT OR RESIDENT DURING THE COURSE OF THE PATIENT 'S STAY OR23 RESIDENCY AT A HEALTH -CARE FACILITY AND WHO MAY VISIT THE24 PATIENT OR RESIDENT AND EXERCISE THE PATIENT 'S OR RESIDENT'S25 VISITATION RIGHTS ON BEHALF OF THE PATIENT OR RESIDENT WHEN THE26 PATIENT OR RESIDENT IS INCAPACITATED OR OTHERWISE UNABLE TO27 053 -3- COMMUNICATE.1 (II) W HEN A PATIENT OR RESIDENT HAS NOT DESIGNATED A2 SUPPORT PERSON PURSUANT TO SUBSECTION (2)(b)(I) OF THIS SECTION3 AND IS INCAPACITATED OR OTHERWISE UNABLE TO COMMUNICATE THE4 PATIENT'S OR RESIDENT'S WISHES AND AN INDIVIDUAL PROVIDES AN5 ADVANCE MEDICAL DIRECTIVE DESIGNATING THE INDIVIDUAL AS THE6 PATIENT'S OR RESIDENT'S SUPPORT PERSON OR OTHER TERM INDICATING7 THE INDIVIDUAL IS AUTHORIZED TO EXERCISE RIGHTS COVERED BY THIS8 SECTION ON BEHALF OF THE PATIENT OR RESIDENT , THE HEALTH-CARE9 FACILITY SHALL ACCEPT THIS DESIGNATION AND ALLOW THE INDIVIDUAL10 TO EXERCISE THE PATIENT'S OR RESIDENT'S VISITATION RIGHTS ON THE11 PATIENT'S OR RESIDENT'S BEHALF.12 (3) (a) C ONSISTENT WITH 42 CFR 482.13 (h); 42 U.S.C.13 1396r (c)(3)(C); 42 U.S.C. 1395i (c)(3)(C); 42 CFR 483.10 (a), (b), AND14 (f); AND SECTION 25-27-104, A HEALTH-CARE FACILITY SHALL HAVE15 WRITTEN POLICIES AND PROCEDURES REGARDING THE VISITATION RIGHTS16 OF PATIENTS AND RESIDENTS , INCLUDING POLICIES AND PROCEDURES17 SETTING FORTH ANY NECESSARY OR REASONABLE RESTRICTION OR18 LIMITATION TO ENSURE HEALTH AND SAFETY OF PATIENTS , STAFF, OR19 VISITORS THAT THE HEALTH -CARE FACILITY MAY NEED TO PLACE ON20 PATIENT OR RESIDENT VISITATION RIGHTS AND THE REASONS FOR THE21 RESTRICTION OR LIMITATION.22 (b) (I) DURING A PERIOD WHEN THE RISK OF TRANSMISSION OF A23 COMMUNICABLE DISEASE IS HEIGHTENED , A HEALTH-CARE FACILITY24 MAY:25 (A) R EQUIRE VISITORS TO ENTER THE HEALTH -CARE FACILITY26 THROUGH A SINGLE, DESIGNATED ENTRANCE;27 053 -4- (B) DENY ENTRANCE TO A VISITOR WHO HAS KNOWN SYMPTOMS1 OF THE COMMUNICABLE DISEASE AND SHOULD ENCOURAGE THE VISITOR2 TO SEEK CARE;3 (C) R EQUIRE VISITORS TO USE MEDICAL MASKS, FACE COVERINGS,4 OR OTHER PERSONAL PROTECTIVE EQUIPMENT WHILE ON THE5 HEALTH-CARE FACILITY PREMISES OR IN SPECIFIC AREAS OF THE6 HEALTH-CARE FACILITY; 7 (D) FOR A HOSPITAL, REQUIRE VISITORS TO SIGN A WAIVER8 ACKNOWLEDGING THE RISKS OF ENTERING THE HEALTH -CARE FACILITY,9 WAIVING ANY CLAIMS AGAINST THE HEALTH -CARE FACILITY IF THE10 VISITOR CONTRACTS THE COMMUNICABLE DISEASE WHILE ON THE11 HEALTH-CARE FACILITY PREMISES, AND ACKNOWLEDGING THAT MENACING12 AND PHYSICAL ASSAULTS ON HEALTH -CARE WORKERS AND OTHER13 EMPLOYEES OF THE HEALTH -CARE FACILITY WILL NOT BE TOLERATED,14 AND, IF SUCH ABUSE OCCURS, A HOSPITAL MAY RESTRICT THE VISITOR'S15 CURRENT OR FUTURE ACCESS; AND16 (E) FOR ALL OTHER HEALTH-CARE FACILITIES, REQUIRE VISITORS17 TO SIGN A DOCUMENT ACKNOWLEDGING THE RISKS OF ENTERING THE18 HEALTH-CARE FACILITY AND ACKNOWLEDGING THAT MENACING AND19 PHYSICAL ASSAULTS ON HEALTH-CARE WORKERS AND OTHER EMPLOYEES20 OF THE HEALTH-CARE FACILITY WILL NOT BE TOLERATED .21 22 (F) REQUIRE ALL VISITORS, BEFORE ENTERING THE HEALTH-CARE23 FACILITY, TO BE SCREENED FOR SYMPTOMS OF THE COMMUNICABLE24 DISEASE AND DENY ENTRANCE TO ANY VISITOR WHO HAS SYMPTOMS OF25 THE COMMUNICABLE DISEASE; AND26 (G) REQUIRE ALL VISITORS TO THE HEALTH-CARE FACILITY TO BE27 053 -5- TESTED FOR THE COMMUNICABLE DISEASE AND DENY ENTRY FOR THOSE1 WHO HAVE A POSITIVE TEST RESULT; AND2 (H) RESTRICT THE MOVEMENT OF VISITORS WITHIN THE3 HEALTH-CARE FACILITY, INCLUDING RESTRICTING ACCESS TO WHERE4 IMMUNOCOMPROMISED OR OTHERWISE VULNERABLE POPULATIONS ARE AT5 GREATER RISK OF BEING HARMED BY A COMMUNICABLE DISEASE .6 (II) FOR VISITATION OF A PATIENT OR RESIDENT WITH A7 COMMUNICABLE DISEASE WHO IS ISOLATED , THE HEALTH-CARE FACILITY8 MAY:9 (A) L IMIT VISITATION TO ESSENTIAL CAREGIVERS WHO ARE10 HELPING TO PROVIDE CARE TO THE PATIENT OR RESIDENT ;11 (B) L IMIT VISITATION TO ONE CAREGIVER AT A TIME PER PATIENT12 OR RESIDENT WITH A COMMUNICABLE DISEASE ;13 (C) S CHEDULE VISITORS TO ALLOW ADEQUATE TIME FOR14 SCREENING, EDUCATION, AND TRAINING OF VISITORS AND TO COMPLY WITH15 ANY LIMITS ON THE NUMBER OF VISITORS PERMITTED IN THE ISOLATED16 AREA AT ONE TIME; AND17 18 (D) PROHIBIT THE PRESENCE OF VISITORS DURING19 AEROSOL-GENERATING PROCEDURES OR DURING COLLECTION OF20 RESPIRATORY SPECIMENS.21 (4) I F A HEALTH-CARE FACILITY REQUIRES, PURSUANT TO22 SUBSECTION (3) OF THIS SECTION, THAT A VISITOR USE A MEDICAL MASK,23 FACE COVERING, OR OTHER PERSONAL PROTECTIVE EQUIPMENT, OR TAKE24 A TEST FOR A COMMUNICABLE DISEASE, IN ORDER TO VISIT A PATIENT OR25 RESIDENT AT THE HEALTH-CARE FACILITY, NOTHING IN THIS SECTION:26 (a) R EQUIRES THE HEALTH-CARE FACILITY, IF THE REQUIRED27 053 -6- EQUIPMENT OR TEST IS NOT AVAILABLE DUE TO LACK OF SUPPLY , TO1 ALLOW A VISITOR TO ENTER THE FACILITY;2 (b) R EQUIRES THE HEALTH-CARE FACILITY TO SUPPLY THE3 REQUIRED EQUIPMENT OR TEST TO THE VISITOR OR BEAR THE COST OF THE4 EQUIPMENT FOR THE VISITOR; OR5 (c) P RECLUDES THE HEALTH-CARE FACILITY FROM SUPPLYING THE6 REQUIRED EQUIPMENT OR TEST TO THE VISITOR.7 (5) A S USED IN THIS SECTION, UNLESS THE CONTEXT OTHERWISE8 REQUIRES:9 (a) "A DVANCE MEDICAL DIRECTIVE" HAS THE SAME MEANING AS10 SET FORTH IN SECTION 15-18.7-102 (2).11 (b) "C AREGIVER" MEANS A PARENT, SPOUSE, OR OTHER FAMILY12 MEMBER OR FRIEND OF A PATIENT WHO PROVIDES CARE TO THE PATIENT .13 (c) "C OMMUNICABLE DISEASE" HAS THE SAME MEANING AS SET14 FORTH IN SECTION 25-1.5-102 (1)(a)(IV).15 (d) (I) "C OMPASSIONATE CARE VISIT" MEANS A VISIT WITH A16 FRIEND OR FAMILY MEMBER THAT IS NECESSARY TO MEET THE PHYSICAL17 OR MENTAL NEEDS OF A PATIENT OR RESIDENT WHEN THE PATIENT OR18 RESIDENT IS EXHIBITING SIGNS OF PHYSICAL OR MENTAL DISTRESS ,19 INCLUDING:20 (A) E ND-OF-LIFE SITUATIONS;21 (B) A DJUSTMENT SUPPORT AFTER MOVING TO A NEW FACILITY OR22 ENVIRONMENT;23 (C) E MOTIONAL SUPPORT AFTER THE LOSS OF A FRIEND OR FAMILY24 MEMBER;25 (D) P HYSICAL SUPPORT AFTER EATING OR DRINKING ISSUES ,26 INCLUDING WEIGHT LOSS OR DEHYDRATION ; OR27 053 -7- (E) SOCIAL SUPPORT AFTER FREQUENT CRYING , DISTRESS, OR1 DEPRESSION.2 (II) "C OMPASSIONATE CARE VISIT" INCLUDES A VISIT FROM:3 (A) A CLERGY MEMBER OR LAYPERSON OFFERING RELIGIOUS OR4 SPIRITUAL SUPPORT; OR5 (B) O THER PERSONS REQUESTED BY THE PATIENT OR RESIDENT FOR6 THE PURPOSE OF A COMPASSIONATE CARE VISIT .7 (e) "H EALTH-CARE FACILITY" MEANS A HOSPITAL, NURSING CARE8 FACILITY, OR ASSISTED LIVING RESIDENCE LICENSED OR CERTIFIED BY THE9 DEPARTMENT PURSUANT TO SECTION 25-3-101.10 11 (f) "PATIENT OR RESIDENT WITH A DISABILITY" MEANS A PATIENT12 OR RESIDENT WHO NEEDS ASSISTANCE TO EFFECTIVELY COMMUNICATE13 WITH HEALTH-CARE FACILITY STAFF, MAKE HEALTH-CARE DECISIONS, OR14 ENGAGE IN ACTIVITIES OF DAILY LIVING DUE TO A DISABILITY SUCH AS :15 (I) A PHYSICAL, INTELLECTUAL, BEHAVIORAL, OR COGNITIVE16 DISABILITY;17 (II) D EAFNESS, BEING HARD OF HEARING , OR OTHER18 COMMUNICATION BARRIERS ;19 (III) B LINDNESS;20 (IV) A UTISM SPECTRUM DISORDER; OR21 (V) D EMENTIA.22 SECTION 3. Appropriation. For the 2022-23 state fiscal year,23 $45,409 is appropriated to the department of public health and24 environment for use by the health facilities and emergency medical25 services division. This appropriation is from the general fund and is based26 on an assumption that the division will require an additional 0.6 FTE. To27 053 -8- implement this act, the division may use this appropriation for the nursing1 and acute care facility survey.2 SECTION 4. Safety clause. The general assembly hereby finds,3 determines, and declares that this act is necessary for the immediate4 preservation of the public peace, health, or safety.5 053 -9-