Rhode Island 2023 Regular Session

Rhode Island Senate Bill S1001 Compare Versions

Only one version of the bill is available at this time.

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5	5	2023 -- S 1001
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7	7	LC002735
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9	9	S TATE OF RHODE IS LAND
10	10	IN GENERAL ASSEMBLY
11	11	JANUARY SESSION, A.D. 2023
12	12	____________
13	13
14	14	A N A C T
15	15	RELATING TO HEALTH AND SAFETY -- HOME CARE PATIENTS RIGHTS
16	16	Introduced By: Senators Cano, Kallman, DiMario, F. Lombardi, Lawson, Mack, Miller,
17	17	Euer, Lauria, and Murray
18	18	Date Introduced: May 15, 2023
19	19	Referred To: Senate Health & Human Services
20	20
21	21
22	22	It is enacted by the General Assembly as follows:
23	23	SECTION 1. Section 23-17.16-5 of the General Laws in Chapter 23-17.16 entitled "Home 1
24	24	Care Patient Rights" is hereby amended to read as follows: 2
25	25	23-17.16-5. Rights of home care patients/clients. 3
26	26	Each home care patient/client has the following rights: 4
27	27	(1) To receive services without regard to race, creed, color, gender, sexual orientation, age, 5
28	28	disability, or source of payment. 6
29	29	(2) To receive safe, appropriate and high quality care and services in a timely manner with 7
30	30	consideration, dignity, respect and privacy. 8
31	31	(3) To accept or refuse care and to be informed of the consequences of that action. 9
32	32	(4) To be free from mental or physical abuse, physical punishment, neglect, damage to or 10
33	33	theft of property, or exploitation of any kind. 11
34	34	(5) To have his or her property treated with respect. 12
35	35	(6) To exercise his or her rights as a patient/client of the home nursing-care provider or 13
36	36	home-care provider agency. When the patient/client is unable to exercise his or her rights, an agent 14
37	37	or legal guardian may exercise the patient’s/client’s rights. 15
38	38	(7) To be informed, in advance, about the care to be furnished (and not to be furnished), 16
39	39	the plan of care, and of any changes in the care to be furnished before the change is made. 17
40	40	(8) To help plan the care and services received or to help change the care and services. 18
41	41	(9) To be advised in advance of the disciplines that will furnish care, the frequency of visits 19
42	42
43	43
44	44	LC002735 - Page 2 of 9
45	45	proposed to be furnished, and the names and qualifications of all individuals providing care. 1
46	46	(10) To receive information necessary to make decisions about care (or to have a family 2
47	47	member receive that information, as appropriate) and to have access to their records. 3
48	48	(11) To receive information and counseling about advanced directives such as the living 4
49	49	will and durable power of attorney for health care, to formulate advanced directives, and to receive 5
50	50	written information about the policy of the home nursing care provider or home care provider 6
51	51	agency on client advanced directives and state COMFORT ONE protocol. 7
52	52	(12) To have his or her personal and clinical records treated and maintained in a 8
53	53	confidential manner and to be advised by the agency of its policies and procedures regarding 9
54	54	disclosure of clinical records. 10
55	55	(13) To be advised, before care is initiated, if the provider is a full participating provider 11
56	56	in the patient’s/client’s healthcare plan, the cost of services, the extent to which payment for the 12
57	57	home nursing-care provider or home-care provider agency services may be expected from 13
58	58	insurance, government and other sources, and the extent to which payment may be required from 14
59	59	the patient/client and the charges they will be required to pay. 15
60	60	(14) To be informed of the home nursing-care provider or home-care provider agency’s 16
61	61	billing procedures and the patient/client payment responsibilities. 17
62	62	(15) To be informed of the home nursing-care provider or home-care provider agency’s 18
63	63	ownership and control. 19
64	64	(16) To be informed of any experimental research or investigational activities and the right 20
65	65	to refuse them. 21
66	66	(17) To voice grievances (or to have the patient’s/client’s family or guardian voice 22
67	67	grievances on the patient’s/client’s behalf if the patient/client is unable to do so) regarding 23
68	68	treatment or care that is (or fails to be) furnished, or regarding the lack of respect for property by 24
69	69	anyone who is furnishing services on behalf of the home nursing-care provider or home-care 25
70	70	provider agency; to be advised on how to voice grievances; and not to be subjected to discrimination 26
71	71	or reprisal for doing so. 27
72	72	(18) To have the patient’s/client’s complaints investigated, or complaints made by the 28
73	73	patient’s/client’s family or guardian, regarding treatment or care that is (or fails to be) furnished, 29
74	74	or regarding the lack of respect for the patient/client or the patient’s/client’s property by anyone 30
75	75	furnishing services on behalf of the home nursing-care provider or home-care provider agency, and 31
76	76	the home nursing-care provider or home-care provider agency must document both the existence 32
77	77	of the complaint and the resolution of the complaint. 33
78	78	(19) To be informed, in writing, of his or her rights to appeal a determination or decision 34
79	79
80	80
81	81	LC002735 - Page 3 of 9
82	82	made by the home nursing-care provider or home-care provider agency with regard to eligibility 1
83	83	for service, the types or levels of service in the care plan, a termination or change in service, or if 2
84	84	the patient/client feels that his or her rights under this chapter have been violated. 3
85	85	(20) To be advised, in writing, of the names, addresses, and telephone numbers of the state 4
86	86	ombudsperson, the attorney general’s Medicaid fraud control unit, the state licensing agency and 5
87	87	the availability of the state toll-free home health hotline, the hours of its operation, and that the 6
88	88	purpose of the hotline is to receive complaints or questions about local home nursing-care providers 7
89	89	or home-care providers. 8
90	90	(21) The patient/client shall have the right to receive information concerning hospice care, 9
91	91	including the benefits of hospice care, the cost, and how to enroll in hospice care. 10
92	92	(22) To receive home care services regardless of the patient’s/client’s permanent or 11
93	93	temporary residence. 12
94	94	SECTION 2. Section 27-18-3 of the General Laws in Chapter 27-18 entitled "Accident and 13
95	95	Sickness Insurance Policies" is hereby amended to read as follows: 14
96	96	27-18-3. Required provisions. 15
97	97	(a) Except as provided in § 27-18-5 each policy delivered or issued for delivery to any 16
98	98	person in this state shall contain the provisions specified in this section in the words in which the 17
99	99	provisions appear in this section; provided, that the insurer may, at its option, substitute, for one or 18
100	100	more of the provisions, corresponding provisions of different wording approved by the 19
101	101	commissioner which are in each instance not less favorable in any respect to the insured or the 20
102	102	beneficiary. The provisions shall be preceded individually by the caption appearing in this 21
103	103	subsection or, at the option of the insurer, by the appropriate individual or group captions or 22
104	104	subcaptions as the commissioner may approve: 23
105	105	(1) A provision as follows: 24
106	106	“ENTIRE CONTRACT; CHANGES: This policy, including the endorsements and the 25
107	107	attached papers, if any, constitutes the entire contract of insurance. No change in this policy shall 26
108	108	be valid until approved by an executive officer of the insurer and unless the approval is endorsed 27
109	109	on it or attached to it. No agent has authority to change this policy or to waive any of its provisions.” 28
110	110	(2) A provision as follows: 29
111	111	“TIME LIMIT ON CERTAIN DEFENSES: (a) After three (3) years from the date of issue 30
112	112	of this policy no misstatements, except fraudulent misstatements, made by the applicant in the 31
113	113	application for this policy shall be used to void the policy or to deny a claim for loss incurred or 32
114	114	disability (as defined in the policy) commencing after the expiration of that three-year period.” 33
115	115	(This policy provision shall not be construed as to affect any legal requirement for 34
116	116
117	117
118	118	LC002735 - Page 4 of 9
119	119	avoidance of a policy or denial of a claim during the initial three (3) year period, nor to limit the 1
120	120	application of § 27-18-4(1), (2), (3), (4) and (5) in the event of a misstatement with respect to age 2
121	121	or occupation or other insurance.) 3
122	122	(A policy which the insured has the right to continue in force subject to its terms by the 4
123	123	timely payment of premium: (i) until at least age fifty (50); or (ii) in the case of a policy issued after 5
124	124	age forty-four (44), for at least five (5) years from its date of issue, may contain in lieu of this 6
125	125	provision the following provision (from which the clause in parentheses may be omitted at the 7
126	126	insurer's option) under the caption “INCONTESTABLE”: 8
127	127	“After this policy has been in force for a period of three (3) years during the lifetime of the 9
128	128	insured (excluding any period during which the insured is disabled), it shall become incontestable 10
129	129	as to the statements contained in the application.”) 11
130	130	“(b) No claim for loss incurred or disability (as defined in the policy) commencing after 12
131	131	three (3) years from the date of issue of this policy shall be reduced or denied on the ground that a 13
132	132	disease or physical condition not excluded from coverage by name or specific description effective 14
133	133	on the date of loss had existed prior to the effective date of coverage of this policy.” 15
134	134	(3) A provision as follows: 16
135	135	“GRACE PERIOD: A grace period of ____” (insert a number not less than “seven” (7) for 17
136	136	weekly premium policies, “ten” (10) for monthly premium policies and “thirty-one” (31) for all 18
137	137	other policies) “days will be granted for the payment of each premium falling due after the first 19
138	138	premium, during which grace period the policy shall continue in force.” 20
139	139	(A policy which contains a cancellation provision may add, at the end of the above 21
140	140	provision: 22
141	141	“subject to the right of the insurer to cancel in accordance with the cancellation provision 23
142	142	of this policy.”) 24
143	143	(A policy in which the insurer reserves the right to refuse any renewal shall have, at the 25
144	144	beginning of the above provision: 26
145	145	“Unless not less than ten (10) days prior to the premium due date the insurer has delivered 27
146	146	to the insured or has mailed to his or her last address as shown by the records of the insurer written 28
147	147	notice of its intention not to renew this policy beyond the period for which the premium has been 29
148	148	accepted,”) 30
149	149	(4) A provision as follows: 31
150	150	“REINSTATEMENT: If any renewal premium is not paid within the time granted the 32
151	151	insured for payment, a subsequent acceptance of premium by the insurer or by any agent duly 33
152	152	authorized by the insurer to accept this premium, without requiring in connection with it an 34
153	153
154	154
155	155	LC002735 - Page 5 of 9
156	156	application for reinstatement, shall reinstate the policy; provided, that if the insurer or the agent 1
157	157	requires an application for reinstatement and issues a conditional receipt for the premium tendered, 2
158	158	the policy will be reinstated upon approval of the application by the insurer or, lacking approval, 3
159	159	upon the forty-fifth day following the date of the conditional receipt unless the insurer has 4
160	160	previously notified the insured in writing of its disapproval of the application. The reinstated policy 5
161	161	shall cover only loss resulting from an accidental injury as may be sustained after the date of 6
162	162	reinstatement and loss due to a sickness as may begin more than ten (10) days after this date. In all 7
163	163	other respects the insured and insurer shall have the same rights under the reinstated policy as they 8
164	164	had under the policy immediately before the due date of the defaulted premium, subject to any 9
165	165	provisions endorsed on it or attached to it in connection with the reinstatement. Any premium 10
166	166	accepted in connection with a reinstatement shall be applied to a period for which the premium has 11
167	167	not been previously paid, but not to any period more than sixty (60) days prior to the date of 12
168	168	reinstatement.” 13
169	169	(The last sentence of this provision may be omitted from any policy which the insured has 14
170	170	the right to continue in force subject to its terms by the timely payment of premiums: (i) until at 15
171	171	least age fifty (50); or (ii) in the case of a policy issued after age forty-four (44), for at least five (5) 16
172	172	years from its date of issue.) 17
173	173	(5) A provision as follows: 18
174	174	“NOTICE OF CLAIM: Written notice of claim must be given to the insurer within twenty 19
175	175	(20) days after the occurrence or commencement of any loss covered by the policy, or as soon after 20
176	176	this as is reasonably possible. Notice given by or on behalf of the insured or the beneficiary to the 21
177	177	insurer at ____________” (insert the location of any office as the insurer may designate for the 22
178	178	purpose), “or to any authorized agent of the insurer, with information sufficient to identify the 23
179	179	insured, shall be deemed notice to the insurer.” 24
180	180	(In a policy providing a loss of time benefit which may be payable for at least two (2) years, 25
181	181	an insurer may at its option insert the following between the first and second sentences of this 26
182	182	provision: 27
183	183	“Subject to the qualifications set forth below, if the insured suffers loss of time on account 28
184	184	of disability for which indemnity may be payable for at least two (2) years, the insured shall, at 29
185	185	least once in every six (6) months after having given notice of claim, give to the insurer notice of 30
186	186	continuance of the disability, except in the event of legal incapacity. The period of six (6) months 31
187	187	following any filing of proof by the insured or any payment by the insurer on account of the claim 32
188	188	or any denial of liability in whole or in part by the insurer shall be excluded in applying this 33
189	189	provision. Delay in the giving of notice shall not impair the insured's right to any indemnity which 34
190	190
191	191
192	192	LC002735 - Page 6 of 9
193	193	would have accrued during the period of six (6) months preceding the date on which the notice is 1
194	194	actually given.”) 2
195	195	(6) A provision as follows: 3
196	196	“CLAIM FORMS: The insurer, upon receipt of a notice of claim, will furnish to the 4
197	197	claimant any forms as are usually furnished by it for filing proofs of loss. If the forms are not 5
198	198	furnished within fifteen (15) days after the giving of notice, the claimant shall be deemed to have 6
199	199	complied with the requirements of this policy as to proof of loss upon submitting, within the time 7
200	200	fixed in the policy for filing proofs of loss, written proof covering the occurrence, the character, 8
201	201	and the extent of the loss for which claim is made.” 9
202	202	(7) A provision as follows: 10
203	203	“PROOFS OF LOSS: Written proof of loss must be furnished to the insurer at its office in 11
204	204	the case of a claim for loss for which this policy provides any periodic payment contingent upon 12
205	205	continuing loss within ninety (90) days after the termination of the period for which the insurer is 13
206	206	liable and in the case of a claim for any other loss within ninety (90) days after the date of the loss. 14
207	207	Failure to furnish proof within the time required shall not invalidate nor reduce any claim if it was 15
208	208	not reasonably possible to give proof within this time, provided the proof is furnished as soon as 16
209	209	reasonably possible and in no event, except in the absence of legal capacity, later than one year 17
210	210	from the time proof is required.” 18
211	211	(8) A provision as follows: 19
212	212	“TIME OF PAYMENT OF CLAIMS: Indemnities payable under this policy for any loss 20
213	213	other than loss for which this policy provides any periodic payment will be paid immediately upon 21
214	214	receipt of due written proof of this loss. Subject to due written proof of loss, all accrued indemnities 22
215	215	for loss for which this policy provides periodic payment will be paid ____________” (insert period 23
216	216	for payments which must not be less frequently than monthly) “and any balance remaining unpaid 24
217	217	upon the termination of liability will be paid immediately upon receipt of due written proof.” 25
218	218	(9) A provision as follows: 26
219	219	“PAYMENT OF CLAIMS: Indemnity for loss of life will be payable in accordance with 27
220	220	the beneficiary designation and the provisions respecting the payment which may be prescribed in 28
221	221	this policy and effective at the time of payment. If no designation or provision is effective, 29
222	222	indemnity shall be payable to the estate of the insured. Any other accrued indemnities unpaid at the 30
223	223	insured's death may, at the option of the insurer, be paid either to the beneficiary or to the estate. 31
224	224	All other indemnities will be payable to the insured.” 32
225	225	(The following provisions, or either of them, may be included with this provision at the 33
226	226	option of the insurer: 34
227	227
228	228
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230	230	“If any indemnity of this policy shall be payable to the estate of the insured, or to an insured 1
231	231	or beneficiary who is a minor or not competent to give a valid release, the insurer may pay the 2
232	232	indemnity, up to an amount not exceeding $______” (insert an amount which shall not exceed one 3
233	233	thousand dollars ($1,000)), “to any relative by blood or connection by marriage of the insured or 4
234	234	beneficiary who is deemed by the insurer to be equitably entitled to the payment. Any payment 5
235	235	made by the insurer in good faith pursuant to this provision shall fully discharge the insurer to the 6
236	236	extent of the payment.” “Subject to any written direction of the insured in the application or 7
237	237	otherwise, all or a portion of any indemnities provided by this policy on account of hospital, 8
238	238	nursing, medical, or surgical services may, at the insurer’s option and unless the insured requests 9
239	239	otherwise in writing not later than the time of filing proofs of the loss, be paid directly to the hospital 10
240	240	or person rendering the services; but it is not required that the service be rendered by a particular 11
241	241	hospital or person.”) 12
242	242	(10) A provision as follows: 13
243	243	“PHYSICAL EXAMINATIONS AND AUTOPSY: The insurer at its own expense shall 14
244	244	have the right and opportunity to examine the person of the insured when and as often as it may 15
245	245	reasonably require during the pendency of a claim under this policy and to make an autopsy in case 16
246	246	of death where it is not forbidden by law.” 17
247	247	(11) A provision as follows: 18
248	248	“LEGAL ACTIONS: No action at law or in equity shall be brought to recover on this policy 19
249	249	prior to the expiration of sixty (60) days after written proof of loss has been furnished in accordance 20
250	250	with the requirements of this policy. No action shall be brought after the expiration of three (3) 21
251	251	years after the time written proof of loss is required to be furnished.” 22
252	252	(12) A provision as follows: 23
253	253	“CHANGE OF BENEFICIARY: Unless the insured makes an irrevocable designation of 24
254	254	beneficiary, the right to change of beneficiary is reserved to the insured and the consent of the 25
255	255	beneficiary or beneficiaries shall not be requisite to surrender or assignment of this policy or to any 26
256	256	change of beneficiary or beneficiaries, or to any other changes in this policy.” 27
257	257	(The first clause of this provision, relating to the irrevocable designation of beneficiary, 28
258	258	may be omitted at the insurer's option.) 29
259	259	(13) A provision as follows: 30
260	260	“‘Medical services’ means those professional services and supplies rendered by or under 31
261	261	the direction of persons duly licensed under the laws of this state to practice medicine, surgery, or 32
262	262	podiatry as may be specified by any medical service plan. Medical service shall not be construed 33
263	263	to include hospital services.” 34
264	264
265	265
266	266	LC002735 - Page 8 of 9
267	267	(c)(1) Each policy issued and/or renewed shall contain a minimum home health care benefit 1
268	268	as follows: 2
269	269	(i) “Home health care” is defined as a medically necessary program to reduce the length of 3
270	270	a hospital stay or to delay or eliminate an otherwise medically necessary hospital admission; 4
271	271	(ii) The home health care program shall be formulated and supervised by the subscriber's 5
272	272	physician; 6
273	273	(iii) Minimum home health care coverage shall not exceed six (6) home or office 7
274	274	physician's visits per month, and shall not exceed three (3) nursing visits per week, home health 8
275	275	aide visits up to twenty (20) hours per week, and the following services as needed: physical or 9
276	276	occupational therapy as a rehabilitative service, respiratory service, speech therapy, medical social 10
277	277	work, nutrition counseling, prescription drugs and medication, medical and surgical supplies, such 11
278	278	as dressings, bandages, and casts, minor equipment such as commodes and walkers, laboratory 12
279	279	testing, x-rays and E.E.G. and E.K.G. evaluations; and 13
280	280	(iv) Communicable diseases and/or nervous, emotional and mental illness are excluded 14
281	281	from home health care coverage; and 15
282	282	(v) Home health care coverage provides coverage for care at an insured's primary residence 16
283	283	or home and any temporary stay of an insured at a private residence or home. 17
284	284	(2) The commissioner shall approve the wording in each policy that in each instance shall 18
285	285	not be less favorable in any respect to the insured or the beneficiary, as the benefits are outlined in 19
286	286	subdivision (1) of this subsection. Any accident and sickness insurance policy whose benefits are 20
287	287	limited to income protection or the furnishing of disability income or a limited benefit health 21
288	288	coverage are excluded from this subsection. Notwithstanding the provisions of § 27-18-19(3), the 22
289	289	minimum home health care benefit shall be included in blanket and/or group policies of accident 23
290	290	and sickness insurance; 24
291	291	(3) A “limited benefit policy,” for the purposes of this section, is any accident and sickness 25
292	292	policy that covers one or more specified risks including, but not limited to, accidental death or 26
293	293	injury or specified disease. A policy that broadly covers accident and sickness, but which contains 27
294	294	exclusions and limitations with respect to certain risks or services, is not a limited benefit policy; 28
295	295	(4) With respect to blanket and/or group policies, the provisions of this subsection shall 29
296	296	apply only to services provided to residents of Rhode Island or employees of Rhode Island 30
297	297	employers. 31
298	298	SECTION 3. This act shall take effect upon passage. 32
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300	300	LC002735
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303	303
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305	305	EXPLANATION
306	306	BY THE LEGISLATIVE COUNCIL
307	307	OF
308	308	A N A C T
309	309	RELATING TO HEALTH AND SAFETY -- HOME CARE PATIENTS RIGHTS
310	310	***
311	311	This act would amend the current law so that all home health care patients are entitled to 1
312	312	receive home health care services regardless of their permanent or temporary residence. 2
313	313	This act would take effect upon passage. 3
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315	315	LC002735
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