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General Assembly Raised Bill No. 956
January Session, 2023
LCO No. 3486
Referred to Committee on PUBLIC HEALTH
Introduced by:
(PH)
AN ACT REQUIRING DISCHARGE STANDARDS REGARDING
FOLLOW-UP APPOINTMENTS AND PRESCRIPTION MEDICATIONS
FOR PATIENTS BEING DISCHARGED FROM A HOSPITAL OR
NURSING HOME FACILITY.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. Section 19a-504c of the general statutes is repealed and the 1
following is substituted in lieu thereof (Effective October 1, 2023): 2
(a) For purposes of this section and section 19a-504e: 3
(1) "Caregiver" means any individual who a patient designates as a 4
caregiver to provide post-discharge assistance to the patient in the 5
patient's home in the community. The term "caregiver" includes, but is 6
not limited to, a relative, spouse, partner, friend or neighbor who has a 7
significant relationship with the patient. For the purposes of this 8
section and section 19a-504e, the term caregiver shall not include any 9
individual who receives compensation for providing post-discharge 10
assistance to the patient. 11
(2) "Home" means the dwelling that the patient considers to be the 12
patient's home in the community. The term "home" shall not include, 13 Bill No. 956
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and the provisions of this section and section 19a-504e shall not apply 14
to, a discharge to any rehabilitation facility, hospital, nursing home, 15
assisted living facility, group home or any other setting that was not 16
the patient's home in the community immediately preceding the 17
patient's inpatient admission. 18
(3) "Hospital" has the same meaning as provided in section 19a-490. 19
(4) "Post-discharge assistance" means nonprofessional care provided 20
by a designated caregiver to a patient following the patient's discharge 21
from an inpatient admission to a hospital in accordance with the 22
written discharge plan of care signed by the patient or the patient's 23
representative, including, but not limited to, assisting with basic 24
activities of daily living, instrumental activities of daily living and 25
carrying out support tasks, such as assisting with wound care, 26
administration of medications and use of medical equipment. 27
(b) The Department of Public Health shall adopt regulations, in 28
accordance with the provisions of chapter 54, to set minimum 29
standards for hospital discharge planning services. Such standards 30
shall include, but [not necessarily] need not be limited to, requirements 31
for (1) a written discharge plan prepared in consultation with the 32
patient, or the patient's family or representative, and the patient's 33
physician, including, but not limited to, the date and location of each 34
follow-up medical appointment scheduled prior to the patient's 35
discharge and a list of all medications the patient is currently taking 36
and will continue to take after the patient's discharge, and (2) a 37
procedure for advance notice to the patient of the patient's discharge 38
and provision of a copy of the discharge plan to the patient prior to 39
discharge. 40
(c) Whenever a hospital refers a patient's name to a nursing home as 41
part of the hospital's discharge planning process, or when a hospital 42
patient requests such a referral, the hospital shall make a copy of the 43
patient's hospital record available to the nursing home and shall allow 44
the nursing home access to the patient for purposes of care planning 45 Bill No. 956
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and consultation. 46
(d) Whenever a hospital's discharge planning indicates that an 47
inpatient will be discharged to the patient's home, the hospital shall (1) 48
allow the patient to designate a caregiver at, or prior to, the time that a 49
written copy of the discharge plan is provided to the patient, and (2) 50
transmit in an oral, written or electronic manner to the patient's 51
pharmacy each prescription ordered for the patient prior to discharge 52
that the patient will need after discharge. A patient is not required to 53
designate any individual as a caregiver and any individual designated 54
as a caregiver under this section is not obligated to perform any post-55
discharge assistance for the patient. 56
(e) If an inpatient designates a caregiver pursuant to subsection (d) 57
of this section prior to receiving written discharge instructions, the 58
hospital shall: 59
(1) Record the patient's designation of caregiver, the relationship of 60
the designated caregiver to the patient, and the name, telephone 61
number and address of the patient's designated caregiver in the 62
discharge plan. 63
(2) Make reasonable attempts to notify the patient's designated 64
caregiver of the patient's discharge to the patient's home as soon as 65
practicable. In the event the hospital is unable to contact the 66
designated caregiver, the lack of contact shall not interfere with, delay, 67
or otherwise affect the medical care provided to the patient or an 68
appropriate discharge of the patient. 69
(3) Prior to discharge, provide caregivers with instructions in all 70
post-discharge assistance tasks described in the discharge plan. 71
Training and instructions for caregivers may be conducted in person or 72
through video technology, as determined by the hospital to effectively 73
provide the necessary instruction. Any training or instructions 74
provided to a caregiver shall be provided in nontechnical language, to 75
the extent possible. At a minimum, this instruction shall include: (A) A 76 Bill No. 956
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live or recorded demonstration of the tasks performed by an 77
individual designated by the hospital who is authorized to perform the 78
post-discharge assistance task and is able to perform the 79
demonstration in a culturally competent manner and in accordance 80
with the hospital's requirements to provide language access services 81
under state and federal law; (B) an opportunity for the caregiver to ask 82
questions about the post-discharge assistance tasks; and (C) answers to 83
the caregiver's questions provided in a culturally competent manner 84
and in accordance with the hospital's requirements to provide 85
language access services under state and federal law. 86
(4) Document in the patient's medical record any training for initial 87
implementation of the discharge plan provided to the patient, the 88
patient's representative or the designated caregiver. Any instruction 89
required under subdivision (3) of this subsection shall be documented 90
in the patient's medical record, including, at a minimum, the date, time 91
and contents of the instruction. 92
(f) If the patient agrees, the written discharge materials referenced in 93
this section may include electronic -only versions, and 94
acknowledgment of any such written discharge materials may be 95
documented through electronic means. 96
Sec. 2. Section 19a-535c of the general statutes is repealed and the 97
following is substituted in lieu thereof (Effective October 1, 2023): 98
(a) For purposes of this section and section 19a-535d: 99
(1) "Caregiver" means any individual who a resident designates to 100
provide post-discharge assistance to the resident in the resident's home 101
in the community. The term "caregiver" includes, but is not limited to, 102
a relative, spouse, partner, friend or neighbor who has a significant 103
relationship with the resident. For the purposes of this section and 104
section 19a-535d, the term "caregiver" shall not include any individual 105
who receives compensation for providing post-discharge assistance to 106
the resident. 107 Bill No. 956
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(2) "Home" means the dwelling that the resident considers to be the 108
resident's home in the community. The term "home" shall not include, 109
and the provisions of this section and section 19a-535d, shall not apply 110
to, a discharge to any rehabilitation facility, hospital, assisted living 111
facility, group home or any other setting that was not the resident's 112
home in the community immediately preceding the resident's 113
admission. 114
(3) "Resident" means a resident of a nursing home facility or the 115
resident's representative. 116
(4) "Nursing home facility" has the same meaning as provided in 117
section 19a-521. 118
(5) "Post-discharge assistance" means nonprofessional tasks 119
provided by a designated caregiver to a resident following the 120
resident's discharge from a nursing home facility in accordance with 121
the written discharge plan of care signed by the resident or the 122
resident's representative, which involves assisting with basic activities 123
of daily living, instrumental activities of daily living and carrying out 124
support tasks, such as assisting with wound care, administration of 125
medications and use of medical equipment. 126
(b) The Department of Public Health may adopt regulations, in 127
accordance with the provisions of chapter 54, to set minimum 128
standards for nursing home facility discharge planning services. Any 129
such standards shall include, but need not be limited to, requirements 130
for (1) a written discharge plan prepared in consultation with the 131
resident, or the resident's family or representative, and the resident's 132
physician, including, but not limited to, the date and location of each 133
follow-up medical appointment scheduled prior to the resident's 134
discharge and a list of all medications the resident is currently taking 135
and will continue to take after the resident's discharge, and (2) a 136
procedure for advance notice to the resident of the resident's discharge 137
and provision of a copy of the discharge plan to the resident prior to 138
discharge. 139 Bill No. 956
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(c) Whenever a discharge plan from a nursing home facility 140
indicates that a resident shall be discharged to the resident's home, the 141
nursing home facility shall (1) allow the resident to designate a 142
caregiver at, or prior to, the time that a written copy of the discharge 143
plan is provided to the resident, and (2) transmit in an oral, written or 144
electronic manner to the resident's pharmacy each prescription 145
ordered for the resident prior to discharge that the resident will need 146
after discharge. A resident is not required to designate any individual 147
as a caregiver and any individual designated as a caregiver under this 148
section is not obligated to perform any post-discharge assistance for 149
the resident or agree to receive any instruction required under this 150
section. 151
(d) If a resident designates a caregiver pursuant to subsection (c) of 152
this section prior to receiving written discharge instructions, the 153
nursing home facility shall: 154
(1) Record the resident's designation of caregiver, the relationship of 155
the designated caregiver to the resident and, if known, the name, 156
telephone number and address of the resident's designated caregiver 157
in the discharge plan. 158
(2) Make more than one reasonable attempt to notify the resident's 159
designated caregiver of the resident's discharge to the resident's home 160
as soon as practicable. In the event the nursing home facility is unable 161
to contact the designated caregiver, the lack of contact shall not 162
interfere with, delay, or otherwise affect the medical care provided to 163
the resident or an appropriate discharge of the resident. 164
(3) Prior to discharge, provide caregivers with instructions in all 165
post-discharge assistance tasks described in the discharge plan. 166
Training and instructions for caregivers may be provided in writing or 167
conducted in person or through video technology, as determined by 168
the nursing home facility to effectively provide the necessary 169
instruction. Any training or instructions provided to a caregiver shall 170
be provided in nontechnical language, to the extent possible. At a 171 Bill No. 956
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minimum, this instruction shall include: (A) A written, live or recorded 172
demonstration of the tasks performed by an individual designated by 173
the nursing home facility who is authorized to perform the post-174
discharge assistance task and is able to perform the demonstration in a 175
culturally competent manner and in accordance with the requirements 176
of the nursing home facility to provide language access services under 177
state and federal law; (B) an opportunity for the caregiver to ask 178
questions about the post-discharge assistance tasks; and (C) answers to 179
the caregiver's questions provided in a culturally competent manner 180
and in accordance with the requirements of the nursing home facility 181
to provide language access services under state and federal law. 182
(4) Document in the resident's medical record any training for initial 183
implementation of the discharge plan provided to the resident, the 184
resident's representative or the designated caregiver. Any instruction 185
required under subdivision (3) of this subsection shall be documented 186
in the resident's medical record, including, at a minimum, the date, 187
time and subject of the instruction. 188
This act shall take effect as follows and shall amend the following
sections:
Section 1 October 1, 2023 19a-504c
Sec. 2 October 1, 2023 19a-535c
PH Joint Favorable