Connecticut 2019 Regular Session

Connecticut House Bill HB07103 Compare Versions

Version 1 (Old)

Version 2 (New)

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7	5		General Assembly Raised Bill No. 7103
8	6		January Session, 2019
9	7		LCO No. 3679
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12	10		Referred to Committee on AGING
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14	12
15	13		Introduced by:
16	14		(AGE)
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20	19		AN ACT CONCERNING NU RSING HOME FALLS.
21	20		Be it enacted by the Senate and House of Representatives in General
22	21		Assembly convened:
23	22
24	23		Section 1. Section 19a-550 of the general statutes is repealed and the 1
25	24		following is substituted in lieu thereof (Effective July 1, 2019): 2
26	25		(a) (1) As used in this section, (A) "nursing home facility" has the 3
27	26		same meaning as provided in section 19a-521, (B) "residential care 4
28	27		home" has the same meaning as provided in section 19a-521, and (C) 5
29	28		"chronic disease hospital" means a long-term hospital having facilities, 6
30	29		medical staff and all necessary personnel for the diagnosis, care and 7
31	30		treatment of chronic diseases; and (2) for the purposes of subsections 8
32	31		(c) and (d) of this section, and subsection (b) of section 19a-537, 9
33	32		"medically contraindicated" means a comprehensive evaluation of the 10
34	33		impact of a potential room transfer on the patient's physical, mental 11
35	34		and psychosocial well-being, which determines that the transfer would 12
36	35		cause new symptoms or exacerbate present symptoms beyond a 13
37	36		reasonable adjustment period resulting in a prolonged or significant 14
38	37		negative outcome that could not be ameliorated through care plan 15
39	38		intervention, as documented by a physician or an advanced practice 16 Raised Bill No. 7103
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46	44		registered nurse in a patient's medical record. 17
47	45		(b) There is established a patients' bill of rights for any person 18
48	46		admitted as a patient to any nursing home facility, residential care 19
49	47		home or chronic disease hospital. The patients' bill of rights shall be 20
50	48		implemented in accordance with the provisions of Sections 1919(b), 21
51	49		1919(c), 1919(c)(2), 1919(c)(2)(D) and 1919(c)(2)(E) of the Social Security 22
52	50		Act. The patients' bill of rights shall provide that each such patient: (1) 23
53	51		Is fully informed, as evidenced by the patient's written 24
54	52		acknowledgment, prior to or at the time of admission and during the 25
55	53		patient's stay, of the rights set forth in this section and of all rules and 26
56	54		regulations governing patient conduct and responsibilities; (2) is fully 27
57	55		informed, prior to or at the time of admission and during the patient's 28
58	56		stay, of services available in such facility or chronic disease hospital, 29
59	57		and of related charges including any charges for services not covered 30
60	58		under Titles XVIII or XIX of the Social Security Act, or not covered by 31
61	59		basic per diem rate; (3) in such facility or hospital is entitled to choose 32
62	60		the patient's own physician or advanced practice registered nurse and 33
63	61		is fully informed, by a physician or an advanced practice registered 34
64	62		nurse, of the patient's medical condition unless medically 35
65	63		contraindicated, as documented by the physician or advanced practice 36
66	64		registered nurse in the patient's medical record, and is afforded the 37
67	65		opportunity to participate in the planning of the patient's medical 38
68	66		treatment and to refuse to participate in experimental research; (4) in a 39
69	67		residential care home or a chronic disease hospital is transferred from 40
70	68		one room to another within such home or chronic disease hospital only 41
71	69		for medical reasons, or for the patient's welfare or that of other 42
72	70		patients, as documented in the patient's medical record and such 43
73	71		record shall include documentation of action taken to minimize any 44
74	72		disruptive effects of such transfer, except a patient who is a Medicaid 45
75	73		recipient may be transferred from a private room to a nonprivate 46
76	74		room, provided no patient may be involuntarily transferred from one 47
77	75		room to another within such home or chronic disease hospital if (A) it 48
78	76		is medically established that the move will subject the patient to a 49
79	77		reasonable likelihood of serious physical injury or harm, or (B) the 50 Raised Bill No. 7103
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86	83		patient has a prior established medical history of psychiatric problems 51
87	84		and there is psychiatric testimony that as a consequence of the 52
88	85		proposed move there will be exacerbation of the psychiatric problem 53
89	86		that would last over a significant period of time and require 54
90	87		psychiatric intervention; and in the case of an involuntary transfer 55
91	88		from one room to another within such home or chronic disease 56
92	89		hospital, the patient and, if known, the patient's legally liable relative, 57
93	90		guardian or conservator or a person designated by the patient in 58
94	91		accordance with section 1-56r, is given not less than thirty days' and 59
95	92		not more than sixty days' written notice to ensure orderly transfer 60
96	93		from one room to another within such home or chronic disease 61
97	94		hospital, except where the health, safety or welfare of other patients is 62
98	95		endangered or where immediate transfer from one room to another 63
99	96		within such home or chronic disease hospital is necessitated by urgent 64
100	97		medical need of the patient or where a patient has resided in such 65
101	98		home or chronic disease hospital for less than thirty days, in which 66
102	99		case notice shall be given as many days before the transfer as 67
103	100		practicable; (5) is encouraged and assisted, throughout the patient's 68
104	101		period of stay, to exercise the patient's rights as a patient and as a 69
105	102		citizen, and to this end, has the right to be fully informed about 70
106	103		patients' rights by state or federally funded patient advocacy 71
107	104		programs, and may voice grievances and recommend changes in 72
108	105		policies and services to nursing home facility, residential care home or 73
109	106		chronic disease hospital staff or to outside representatives of the 74
110	107		patient's choice, free from restraint, interference, coercion, 75
111	108		discrimination or reprisal; (6) shall have prompt efforts made by such 76
112	109		nursing home facility, residential care home or chronic disease hospital 77
113	110		to resolve grievances the patient may have, including those with 78
114	111		respect to the behavior of other patients; (7) may manage the patient's 79
115	112		personal financial affairs, and is given a quarterly accounting of 80
116	113		financial transactions made on the patient's behalf; (8) is free from 81
117	114		mental and physical abuse, corporal punishment, involuntary 82
118	115		seclusion and any physical or chemical restraints imposed for 83
119	116		purposes of discipline or convenience and not required to treat the 84
120	117		patient's medical symptoms. Physical or chemical restraints may be 85 Raised Bill No. 7103
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127	123		imposed only to ensure the physical safety of the patient or other 86
128	124		patients and only upon the written order of a physician or an 87
129	125		advanced practice registered nurse that specifies the type of restraint 88
130	126		and the duration and circumstances under which the restraints are to 89
131	127		be used, except in emergencies until a specific order can be obtained; 90
132	128		(9) is assured confidential treatment of the patient's personal and 91
133	129		medical records, and may approve or refuse their release to any 92
134	130		individual outside the facility, except in case of the patient's transfer to 93
135	131		another health care institution or as required by law or third-party 94
136	132		payment contract; (10) receives quality care and services with 95
137	133		reasonable accommodation of individual needs and preferences, 96
138	134		except where the health or safety of the individual would be 97
139	135		endangered, and is treated with consideration, respect, and full 98
140	136		recognition of the patient's dignity and individuality, including 99
141	137		privacy in treatment and in care for the patient's personal needs; (11) is 100
142	138		not required to perform services for the nursing home facility, 101
143	139		residential care home or chronic disease hospital that are not included 102
144	140		for therapeutic purposes in the patient's plan of care; (12) may 103
145	141		associate and communicate privately with persons of the patient's 104
146	142		choice, including other patients, send and receive the patient's 105
147	143		personal mail unopened and make and recei ve telephone calls 106
148	144		privately, unless medically contraindicated, as documented by the 107
149	145		patient's physician or advanced practice registered nurse in the 108
150	146		patient's medical record, and receives adequate notice before the 109
151	147		patient's room or roommate in such facility, home or chronic disease 110
152	148		hospital is changed; (13) is entitled to organize and participate in 111
153	149		patient groups in such facility, home or chronic disease hospital and to 112
154	150		participate in social, religious and community activities that do not 113
155	151		interfere with the rights of other patients, unless medically 114
156	152		contraindicated, as documented by the patient's physician or advanced 115
157	153		practice registered nurse in the patient's medical records; (14) may 116
158	154		retain and use the patient's personal clothing and possessions unless to 117
159	155		do so would infringe upon rights of other patients or unless medically 118
160	156		contraindicated, as documented by the patient's physician or advanced 119
161	157		practice registered nurse in the patient's medical record; (15) is assured 120 Raised Bill No. 7103
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168	163		privacy for visits by the patient's spouse or a person designated by the 121
169	164		patient in accordance with section 1-56r and, if the patient is married 122
170	165		and both the patient and the patient's spouse are inpatients in the 123
171	166		facility, they are permitted to share a room, unless medically 124
172	167		contraindicated, as documented by the attending physician or 125
173	168		advanced practice registered nurse in the medical record; (16) is fully 126
174	169		informed of the availability of and may examine all current state, local 127
175	170		and federal inspection reports and plans of correction; (17) may 128
176	171		organize, maintain and participate in a patient-run resident council, as 129
177	172		a means of fostering communication among residents and between 130
178	173		residents and staff, encouraging resident independence and 131
179	174		addressing the basic rights of nursing home facility, residential care 132
180	175		home and chronic disease hospital patients and residents, free from 133
181	176		administrative interference or reprisal; (18) is entitled to the opinion of 134
182	177		two physicians concerning the need for surgery, except in an 135
183	178		emergency situation, prior to such surgery being performed; (19) is 136
184	179		entitled to have the patient's family or a person designated by the 137
185	180		patient in accordance with section 1-56r meet in such facility, 138
186	181		residential care home or chronic disease hospital with the families of 139
187	182		other patients in the facility to the extent such facility, residential care 140
188	183		home or chronic disease hospital has existing meeting space available 141
189	184		that meets applicable building and fire codes; (20) is entitled to file a 142
190	185		complaint with the Department of Social Services and the Department 143
191	186		of Public Health regarding patient abuse, neglect or misappropriation 144
192	187		of patient property; (21) is entitled to have psychopharmacologic drugs 145
193	188		administered only on orders of a physician or an advanced practice 146
194	189		registered nurse and only as part of a written plan of care developed in 147
195	190		accordance with Section 1919(b)(2) of the Social Security Act and 148
196	191		designed to eliminate or modify the symptoms for which the drugs are 149
197	192		prescribed and only if, at least annually, an independent external 150
198	193		consultant reviews the appropriateness of the drug plan; (22) is 151
199	194		entitled to be transferred or discharged from the facility only pursuant 152
200	195		to section 19a-535, 19a-535a or 19a-535b, as applicable; (23) is entitled 153
201	196		to be treated equally with other patients with regard to transfer, 154
202	197		discharge and the provision of all services regardless of the source of 155 Raised Bill No. 7103
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209	203		payment; (24) shall not be required to waive any rights to benefits 156
210	204		under Medicare or Medicaid or to give oral or written assurance that 157
211	205		the patient is not eligible for, or will not apply for benefits under 158
212	206		Medicare or Medicaid; (25) is entitled to be provided information by 159
213	207		the nursing home facility or chronic disease hospital as to how to 160
214	208		apply for Medicare or Medicaid benefits and how to receive refunds 161
215	209		for previous payments covered by such benefits; (26) is entitled to 162
216	210		receive a copy of any Medicare or Medicaid application completed by 163
217	211		a nursing home facility, residential care home or chronic disease 164
218	212		hospital on behalf of the patient or to designate that a family member, 165
219	213		or other representative of the patient, receive a copy of any such 166
220	214		application; (27) on or after October 1, 1990, shall not be required to 167
221	215		give a third-party guarantee of payment to the facility as a condition of 168
222	216		admission to, or continued stay in, such facility; (28) is entitled to have 169
223	217		such facility not charge, solicit, accept or receive any gift, money, 170
224	218		donation, third-party guarantee or other consideration as a 171
225	219		precondition of admission or expediting the admission of the 172
226	220		individual to such facility or as a requirement for the individual's 173
227	221		continued stay in such facility; [and] (29) shall not be required to 174
228	222		deposit the patient's personal funds in such facility, home or chronic 175
229	223		disease hospital; and (30) if a patient at a nursing home facility, is 176
230	224		informed of the facility's responsibility under federal law to mitigate 177
231	225		patient fall risks, including, but not limited to, providing sufficient 178
232	226		staff supervision of a patient at risk for falls and assistance devices to 179
233	227		prevent such falls. 180
234	228		(c) The patients' bill of rights shall provide that a patient in a rest 181
235	229		home with nursing supervision or a chronic and convalescent nursing 182
236	230		home may be transferred from one room to another within such home 183
237	231		only for the purpose of promoting the patient's well-being, except as 184
238	232		provided pursuant to subparagraph (C) or (D) of this subsection or 185
239	233		subsection (d) of this section. Whenever a patient is to be transferred, 186
240	234		such home shall effect the transfer with the least disruption to the 187
241	235		patient and shall assess, monitor and adjust care as needed subsequent 188
242	236		to the transfer in accordance with subdivision (10) of subsection (b) of 189 Raised Bill No. 7103
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249	242		this section. When a transfer is initiated by such home and the patient 190
250	243		does not consent to the transfer, such home shall establish a 191
251	244		consultative process that includes the participation of the attending 192
252	245		physician or advanced practice registered nurse, a registered nurse 193
253	246		with responsibility for the patient and other appropriate staff in 194
254	247		disciplines as determined by the patient's needs, and the participation 195
255	248		of the patient, the patient's family, a person designated by the patient 196
256	249		in accordance with section 1-56r or other representative. The 197
257	250		consultative process shall determine: (1) What caused consideration of 198
258	251		the transfer; (2) whether the cause can be removed; and (3) if not, 199
259	252		whether such home has attempted alternatives to transfer. The patient 200
260	253		shall be informed of the risks and benefits of the transfer and of any 201
261	254		alternatives. If subsequent to the completion of the consultative 202
262	255		process a patient still does not wish to be transferred, the patient may 203
263	256		be transferred without the patient's consent, unless medically 204
264	257		contraindicated, only (A) if necessary to accomplish physical plant 205
265	258		repairs or renovations that otherwise could not be accomplished; 206
266	259		provided, if practicable, the patient, if the patient wishes, shall be 207
267	260		returned to the patient's room when the repairs or renovations are 208
268	261		completed; (B) due to irreconcilable incompatibility between or among 209
269	262		roommates, which is actually or potentially harmful to the well-being 210
270	263		of a patient; (C) if such home has two vacancies available for patients 211
271	264		of the same sex in different rooms, there is no applicant of that sex 212
272	265		pending admission in accordance with the requirements of section 19a-213
273	266		533 and grouping of patients by the same sex in the same room would 214
274	267		allow admission of patients of the opposite sex, that otherwise would 215
275	268		not be possible; (D) if necessary to allow access to specialized medical 216
276	269		equipment no longer needed by the patient and needed by another 217
277	270		patient; or (E) if the patient no longer needs the specialized services or 218
278	271		programming that is the focus of the area of such home in which the 219
279	272		patient is located. In the case of an involuntary transfer, such home 220
280	273		shall, subsequent to completion of the consultative process, provide 221
281	274		the patient and the patient's legally liable relative, guardian or 222
282	275		conservator if any or other responsible party if known, with at least 223
283	276		fifteen days' written notice of the transfer, which shall include the 224 Raised Bill No. 7103
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290	282		reason for the transfer, the location to which the patient is being 225
291	283		transferred, and the name, address and telephone number of the 226
292	284		regional long-term care ombudsman, except that in the case of a 227
293	285		transfer pursuant to subparagraph (A) of this subsection at least thirty 228
294	286		days' notice shall be provided. Notwithstanding the provisions of this 229
295	287		subsection, a patient may be involuntarily transferred immediately 230
296	288		from one room to another within such home to protect the patient or 231
297	289		others from physical harm, to control the spread of an infectious 232
298	290		disease, to respond to a physical plant or environmental emergency 233
299	291		that threatens the patient's health or safety or to respond to a situation 234
300	292		that presents a patient with an immediate danger of death or serious 235
301	293		physical harm. In such a case, disruption of patients shall be 236
302	294		minimized; the required notice shall be provided not later than 237
303	295		twenty-four hours after the transfer; if practicable, the patient, if the 238
304	296		patient wishes, shall be returned to the patient's room when the threat 239
305	297		to health or safety that prompted the transfer has been eliminated; and, 240
306	298		in the case of a transfer effected to protect a patient or others from 241
307	299		physical harm, the consultative process shall be established on the next 242
308	300		business day. 243
309	301		(d) Notwithstanding the provisions of subsection (c) of this section, 244
310	302		unless medically contraindicated, a patient who is a Medicaid recipient 245
311	303		may be transferred from a private to a nonprivate room. In the case of 246
312	304		such a transfer, the nursing home facility shall (1) give not less than 247
313	305		thirty days' written notice to the patient and the patient's legally liable 248
314	306		relative, guardian or conservator, if any, a person designated by the 249
315	307		patient in accordance with section 1-56r or other responsible party, if 250
316	308		known, which notice shall include the reason for the transfer, the 251
317	309		location to which the patient is being transferred and the name, 252
318	310		address and telephone number of the regional long-term care 253
319	311		ombudsman; and (2) establish a consultative process to effect the 254
320	312		transfer with the least disruption to the patient and assess, monitor 255
321	313		and adjust care as needed subsequent to the transfer in accordance 256
322	314		with subdivision (10) of subsection (b) of this section. The consultative 257
323	315		process shall include the participation of the attending physician or 258 Raised Bill No. 7103
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330	321		advanced practice registered nurse, a registered nurse with 259
331	322		responsibility for the patient and other appropriate staff in disciplines 260
332	323		as determined by the patient's needs, and the participation of the 261
333	324		patient, the patient's family, a person designated by the patient in 262
334	325		accordance with section 1-56r or other representative. 263
335	326		(e) Any nursing home facility, residential care home or chronic 264
336	327		disease hospital that negligently deprives a patient of any right or 265
337	328		benefit created or established for the well-being of the patient by the 266
338	329		provisions of this section shall be liable to such patient in a private 267
339	330		cause of action for injuries suffered as a result of such deprivation, 268
340	331		including, but not limited to, injuries sustained from falls due to a 269
341	332		nursing home facility's failure to mitigate fall risks. Upon a finding that 270
342	333		a patient has been deprived of such a right or benefit, and that the 271
343	334		patient has been injured as a result of such deprivation, damages shall 272
344	335		be assessed in the amount sufficient to compensate such patient for 273
345	336		such injury. The rights or benefits specified in subsections (b) to (d), 274
346	337		inclusive, of this section may not be reduced, rescinded or abrogated 275
347	338		by contract. In addition, where the deprivation of any such right or 276
348	339		benefit is found to have been wilful or in reckless disregard of the 277
349	340		rights of the patient, punitive damages may be assessed. A patient may 278
350	341		also maintain an action pursuant to this section for any other type of 279
351	342		relief, including injunctive and declaratory relief, permitted by law. 280
352	343		Exhaustion of any available administrative remedies shall not be 281
353	344		required prior to commencement of suit under this section. 282
354	345		(f) In addition to the rights specified in subsections (b), (c) and (d) of 283
355	346		this section, a patient in a nursing home facility is entitled to have the 284
356	347		facility manage the patient's funds as provided in section 19a-551. 285
357	348		This act shall take effect as follows and shall amend the following
358	349		sections:
359	350
360	351		Section 1 July 1, 2019 19a-550
361		-
362		-	AGE Joint Favorable Raised Bill No. 7103
	352	+	Raised Bill No. 7103
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	358	+	Statement of Purpose:
	359	+	To mitigate risks and apportion liability for falls experienced by
	360	+	nursing home facility patients.
	361	+	[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline,
	362	+	except that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is
	363	+	not underlined.]
369	364