2014 -- H 7652

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LC004834

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2014

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A N   A C T

RELATING TO HEALTH AND SAFETY -- GENDER DISCRIMINATION

     

     Introduced By: Representatives Walsh, Ajello, Tanzi, Handy, and Craven

     Date Introduced: February 27, 2014

     Referred To: House Corporations

     (Lieutenant Governor)

It is enacted by the General Assembly as follows:

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     SECTION 1. Section 23-17-19.1 of the General Laws in Chapter 23-17 entitled

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"Licensing of Health Care Facilities" is hereby amended to read as follows:

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     23-17-19.1. Rights of patients. -- Every health care facility licensed under this chapter

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shall observe the following standards and any other standards that may be prescribed in rules and

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regulations promulgated by the licensing agency with respect to each patient who utilizes the

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facility:

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      (1) The patient shall be afforded considerate and respectful care.

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      (2) Upon request, the patient shall be furnished with the name of the physician

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responsible for coordinating his or her care.

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      (3) Upon request, the patient shall be furnished with the name of the physician or other

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person responsible for conducting any specific test or other medical procedure performed by the

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health care facility in connection with the patient's treatment.

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      (4) The patient shall have the right to refuse any treatment by the health care facility to

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the extent permitted by law.

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      (5) The patient's right to privacy shall be respected to the extent consistent with

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providing adequate medical care to the patient and with the efficient administration of the health

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care facility. Nothing in this section shall be construed to preclude discreet discussion of a

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patient's case or examination of appropriate medical personnel.

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      (6) The patient's right to privacy and confidentiality shall extend to all records pertaining

 

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to the patient's treatment except as otherwise provided by law.

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      (7) The health care facility shall respond in a reasonable manner to the request of a

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patient's physician, certified nurse practitioner and/or a physician's assistant for medical services

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to the patient. The health care facility shall also respond in a reasonable manner to the patient's

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request for other services customarily rendered by the health care facility to the extent the

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services do not require the approval of the patient's physician, certified nurse practitioner and/or a

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physician's assistant or are not inconsistent with the patient's treatment.

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      (8) Before transferring a patient to another facility, the health care facility must first

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inform the patient of the need for and alternatives to a transfer.

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      (9) Upon request, the patient shall be furnished with the identities of all other health care

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and educational institutions that the health care facility has authorized to participate in the

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patient's treatment and the nature of the relationship between the institutions and the health care

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facility.

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      (10) (a) Except as otherwise provided in this subparagraph, if the health care facility

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proposes to use the patient in any human subjects research, it shall first thoroughly inform the

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patient of the proposal and offer the patient the right to refuse to participate in the project.

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      (b) No facility shall be required to inform prospectively the patient of the proposal and

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the patient's right to refuse to participate when: (i) the facility's human subjects research involves

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the investigation of potentially lifesaving devices, medications and/or treatments and the patient

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is unable to grant consent due to a life-threatening situation and consent is not available from the

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agent pursuant to chapter 23-4.10 of the general laws or the patient's decision maker if an agent

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has not been designated or an applicable advanced directive has not been executed by the patient;

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and (ii) the facility's institutional review board approves the human subjects research pursuant to

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the requirements of 21 CFR Part 50 and/or 45 CFR Part 46 (relating to the informed consent of

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human subjects). Any health care facility engaging in research pursuant to the requirements of

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subparagraph (b) herein shall file a copy of the relevant research protocol with the department of

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health, which filing shall be publicly available.

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      (11) Upon request, the patient shall be allowed to examine and shall be given an

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explanation of the bill rendered by the health care facility irrespective of the source of payment of

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the bill.

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      (12) Upon request, the patient shall be permitted to examine any pertinent health care

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facility rules and regulations that specifically govern the patient's treatment.

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      (13) The patient shall be offered treatment without discrimination as to sexual

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orientation, gender identity or expression, race, color, religion, national origin, or source of

 

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payment.

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      (14) Patients shall be provided with a summarized medical bill within thirty (30) days of

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discharge from a health care facility. Upon request, the patient shall be furnished with an itemized

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copy of his or her bill. When patients are residents of state-operated institutions and facilities, the

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provisions of this subsection shall not apply.

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      (15) Upon request, the patient shall be allowed the use of a personal television set

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provided that the television complies with underwriters' laboratory standards and O.S.H.A.

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standards, and so long as the television set is classified as a portable television.

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      (16) No charge shall be made for furnishing a health record or part of a health record to a

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patient, his or her attorney or authorized representative if the record or part of the record is

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necessary for the purpose of supporting an appeal under any provision of the Social Security Act,

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42 U.S.C. section 301 et seq., and the request is accompanied by documentation of the appeal or a

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claim under the provisions of the Workers' Compensation Act, chapters 29 -- 38 of title 28. A

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provider shall furnish a health record requested pursuant to this section within thirty (30) days of

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the request. Further, for patients of school based health centers, the director is authorized to

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specify by regulation an alternative list of age appropriate rights commensurate with this section.

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      (17) The patient shall have the right to have his or her pain assessed on a regular basis.

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      (18) Notwithstanding any other provisions of this section, upon request, patients

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receiving care through hospitals, nursing homes, assisted living residences and home health care

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providers, shall have the right to receive information concerning hospice care, including the

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benefits of hospice care, the cost, and how to enroll in hospice care.

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     SECTION 2. Section 23-17.4-16 of the General Laws in Chapter 23-17.4 entitled

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"Assisted Living Residence Licensing Act" is hereby amended to read as follows:

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     23-17.4-16. Rights of residents. -- (a) Every assisted living residence for adults licensed

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under this chapter shall observe the following standards and any other appropriate standards as

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may be prescribed in rules and regulations promulgated by the licensing agency with respect to

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each resident of the residence:

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      (1) Residents are entitled to all rights recognized by state and federal law with respect to

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discrimination, service decisions (including the right to refuse services), freedom from abuse and

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neglect, privacy, association, and other areas of fundamental rights including the right to freedom

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of religious practice. Some of these basic rights include:

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      (i) To be offered services without discrimination as to sex, sexual orientation, gender

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identity or expression, race, color, religion, national origin, or source of payment;

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      (ii) To be free from verbal, sexual, physical, emotional, and mental abuse, corporal

 

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punishment, and involuntary seclusion;

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      (iii) To be free from physical or chemical restraints for the purpose of discipline or

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convenience and not required to treat the resident's medical symptoms. No chemical or physical

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restraints will be used except on order of a physician;

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      (iv) To have their medical information protected by applicable state confidentiality laws;

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      (v) To have a service animal, consistent with the "reasonable accommodations" clause of

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the Fair Housing Act, 42 U.S.C. section 3601 et seq. (such as a seeing eye dog); and

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      (2) In addition to these basic rights enjoyed by other adults, the residents of assisted

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living also have the right to:

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      (i) Be treated as individuals and with dignity, and be assured choice and privacy and the

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opportunity to act autonomously;

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      (ii) Upon request have access to all records pertaining to the resident, including clinical

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records, within the next business day or immediately in emergency situations;

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      (iii) Arrange for services not available through the setting at their own expense as long as

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the resident remains in compliance with the resident contract and applicable state law and

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regulations;

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      (iv) Upon admission and during the resident's stay be fully informed in a language the

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resident understands of all resident rights and rules governing resident conduct and

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responsibilities. Each resident shall:

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      (A) Receive a copy of their rights;

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      (B) Acknowledge receipt in writing; and

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      (C) Be informed promptly of any changes;

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      (v) Remain in their room or apartment unless a change in room or apartment is related to

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resident preference or to transfer conditions stipulated in their contract;

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      (vi) Consistent with the terms of the resident contract, furnish their own rooms and

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maintain personal clothing and possessions as space permits, consistent with applicable life

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safety, fire, or similar laws, regulations, and ordinances;

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      (vii) Be encouraged and assisted to exercise rights as a citizen; to voice grievances

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through a documented grievance mechanism and suggest changes in policies and services to

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either staff or outside representatives without fear of restraint, interference, coercion,

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discrimination, or reprisal;

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      (viii) Have visitors of their choice without restrictions so long as those visitors do not

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pose a health or safety risk to other residents, staff, or visitors, or a risk to property, and comply

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with reasonable hours and security procedures;

 

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      (ix) Have personal privacy in their medical treatment, written communications and

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telephone communications, and, to the fullest extent possible, in accommodation, personal care,

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visits, and meetings;

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      (x) Have prominently displayed a posting of the facility's grievance procedure, the

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names, addresses, and telephone numbers of all pertinent resident advocacy groups, the state

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ombudsperson, and the state licensing agency;

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      (xi) Choose his or her own physician(s) and have ready access to the name, specialty,

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and way of contacting the physician(s) responsible for the resident's care;

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      (xii) Have the residence record and periodically update the address and telephone

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number of the resident's legal representative or responsible party;

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      (xiii) Manage his or her financial affairs. The residence may not require residents to

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deposit their personal funds with the residence. Upon written authorization of a resident and with

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the agreement of the residence, the residence holds, safeguards, manages, and accounts for

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personal funds of the resident as follows:

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      (A) Funds in excess of three hundred dollars ($300) must be in an interest bearing

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account, separate from any residence operating account that credits all interest on the resident's

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funds to that account and the residence shall purchase a surety bond on this account;

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      (B) A full and separate accounting of each resident's personal funds maintained must be

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available through quarterly statements and on request of the resident;

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      (C) Resident funds shall not be commingled with residence funds or with funds of any

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person other than another resident;

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      (D) Upon the death of a resident, the residence must convey within thirty (30) days the

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resident's funds deposited with the residence and a full accounting of those funds to the resident's

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responsible party or the administrator of the resident's estate;

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      (xiv) Have access to representatives of the state ombudsperson and to allow the

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ombudsperson to examine a resident's records with the permission of the resident and consistent

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with state law;

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      (xv) Be informed, in writing, prior to or at the time of admission or at the signing of a

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residential contract or agreement of:

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      (A) The scope of the services available through the residence service program, including

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health services, and of all related fees and charges, including charges not covered either under

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federal and/or state programs or by other third party payors or by the residence's basic rate;

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      (B) The residence's policies regarding overdue payment including notice provisions and

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a schedule for late fee charges;

 

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      (C) The residence's policy regarding acceptance of state and federal government

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reimbursement for care in the facility both at time of admission and during the course of

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residency if the resident depletes his or her own private resources;

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      (D) The residence's criteria for occupancy and termination of residency agreements;

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      (E) The residence's capacity to serve residents with physical and cognitive impairments;

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      (F) Support any health services that the residence includes in its service package or will

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make appropriate arrangements to provide the services;

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      (xvi) To be encouraged to meet with and participate in activities of social, religious, and

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community groups at the resident's discretion;

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      (xvii) Upon provision of at least thirty (30) days notice, if a resident chooses to leave a

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residence, the resident shall be refunded any advanced payment made provided that the resident is

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current in all payments;

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      (xviii) To have the residence discharge a resident only for the following reasons and

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within the following guidelines:

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      (A) Except in life threatening emergencies and for nonpayment of fees and costs, the

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residence gives thirty (30) days' advance written notice of termination of residency agreement

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with a statement containing the reason, the effective date of termination, and the resident's right to

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an appeal under state law;

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      (B) If the resident does not meet the requirements for residency criteria stated in the

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residency agreement or requirements of state or local laws or regulations;

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      (C) If the resident is a danger to himself or herself or the welfare of others and the

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residence has attempted to make a reasonable accommodation without success to address the

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resident's behavior in ways that would make termination of residency agreement or change

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unnecessary, which would be documented in the resident's records;

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      (D) For failure to pay all fees and costs stated in the contract, resulting in bills more than

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thirty (30) days outstanding. A resident who has been given notice to vacate for nonpayment of

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rent has the right to retain possession of the premises, up to any time prior to eviction from the

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premises, by tendering to the provider the entire amount of fees for services, rent, interest, and

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costs then due. The provider may impose reasonable late fees for overdue payment; provided that

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the resident has received due notice of those charges in accordance with the residence's policies.

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Chronic and repeated failure to pay rent is a violation of the lease covenant. However the

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residence must make reasonable efforts to accommodate temporary financial hardship and

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provide information on government or private subsidies available that may be available to help

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with costs; and

 

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      (E) The residence makes a good faith effort to counsel the resident if the resident shows

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indications of no longer meeting residence criteria or if service with a termination notice is

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anticipated;

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      (xix) To have the residence provide for a safe and orderly move out, including assistance

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with identifying a resource to help locate another setting, regardless of reason for move out;

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      (xx) To have the resident's responsible person and physician notified when there is:

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      (A) An accident involving the resident that results in injury and required physician

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intervention;

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      (B) A significant change in the resident's physical, mental, or psychosocial status or

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treatment;

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      (xxi) To be able to share a room or unit with a spouse or other consenting resident of the

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residence in accordance with terms of the resident contract;

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      (xxii) To live in a safe and clean environment;

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      (xxiii) To have and use his or her own possessions where reasonable and have an

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accessible lockable space provided for security of small personal valuables;

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      (xxiv) To receive a nourishing, palatable, well balanced diet that meets his or her daily

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nutritional and special medical dietary needs;

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      (xxv) To attain or maintain the highest practicable physical, mental, and psychosocial

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well being;

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      (xxvi) To be allowed to maintain an amount of money to cover reasonable monthly

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personal expenses, the amount of which shall be at least equal to that amount required for

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individuals on SSI as provided under section 40-6-27(a)(3);

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      (xxvii) To have the residence implement written policies and procedures to ensure that

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all facility staff are aware of and protect the resident's rights contained in this section; and

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      (xxviii) Upon request, the resident shall have the right to receive information concerning

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hospice care, including the benefits of hospice care, the cost, and how to enroll in hospice care.

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      (b) For purposes of subdivisions (a)(2)(ii), (iv), (xi), (xiii), (xiv), (xvii), (xviii)(A) and

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(xxviii), the term "resident" also means the resident's agent as designated in writing or legal

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guardian.

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     SECTION 3. Section 23-17.5-19 of the General Laws in Chapter 23-17.5 entitled "Rights

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of Nursing Home Patients" is hereby amended to read as follows:

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     23-17.5-19. Discrimination. -- Each patient shall be offered treatment without

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discrimination as to sex, sexual orientation, gender identity or expression, race, color, religion,

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national origin, source of payment, disability, or diagnosis of Alzheimer's disease or related

 

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dementia.

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     SECTION 4. Chapter 23-17 of the General Laws entitled "Licensing of Health Care

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Facilities" is hereby amended by adding thereto the following section:

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     23-17-60. Anti-Discrimination attestation. -- Every nursing facility, assisted living

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residence, home nursing care provider, or home care provider seeking a new license or renewal of

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a license under this chapter, or chapters 17.4 and 17.5 of this title, shall attest to having in place

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anti-discrimination policies for all persons, regardless of sex, sexual orientation, gender identity

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or expression, race, color, religion, national origin, or source of payment.

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     SECTION 5. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO HEALTH AND SAFETY -- GENDER DISCRIMINATION

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     This act would prohibit discrimination by nursing facilities, assisted living residences,

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home nursing care providers and home care providers on the basis of sex, sexual orientation,

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gender identity or expression.

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     This act would take effect upon passage.

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