Chapter 238

2003 -- H 5924 SUBSTITUTE A

Enacted 07/17/03

A N A C T

RELATING TO HEALTH AND SAFETY -- LICENSING OF HEALTH CARE FACILITIES

Introduced By: Representatives Ginaitt, S Anderson, Costantino, Dennigan, and Naughton

Date Introduced: February 12, 2003

It is enacted by the General Assembly as follows:

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

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

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

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

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

facility:

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

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

responsible for coordinating his or her care.

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

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

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

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

the extent permitted by law.

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

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

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

patient's case or examination of appropriate medical personnel.

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

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

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

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

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

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

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

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

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

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

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

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

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

facility.

(10) If the health care facility proposes to use the patient in any human experimentation

project, it shall first thoroughly inform the patient of the proposal and offer the patient the right to

refuse to participate in the project.

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

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

the bill.

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

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

(13) The patient shall be offered treatment without discrimination as to race, color,

religion, national origin, or source of payment.

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

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

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

provisions of this subsection shall not apply.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

each resident of the residence:

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

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

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

of religious practice. Some of these basic rights include:

(i) To be offered services without discrimination as to sex, race, color, religion, national

origin, or source of payment;

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

punishment, and involuntary seclusion;

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

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

restraints will be used except on order of a physician;

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

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

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

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

living also have the right to:

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

opportunity to act autonomously;

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

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

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

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

regulations;

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

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

responsibilities. Each resident shall:

(A) Receive a copy of their rights;

(B) Acknowledge receipt in writing; and

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

resident preference or to transfer conditions stipulated in their contract;

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

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

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

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

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

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

discrimination, or reprisal;

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

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

with reasonable hours and security procedures;

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

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

visits, and meetings;

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

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

ombudsperson, and the state licensing agency;

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

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

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

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

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

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

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

personal funds of the resident as follows:

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

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

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

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

available through quarterly statements and on request of the resident;

person other than another resident;

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

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

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

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

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

with state law;

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

residential contract or agreement of:

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

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

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

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

a schedule for late fee charges;

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

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

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

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

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

make appropriate arrangements to provide the services;

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

community groups at the resident's discretion;

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

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

current in all payments;

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

within the following guidelines:

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

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

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

an appeal under state law;

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

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

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

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

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

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

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

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

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

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

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

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

residence must make reasonable efforts to accommodate temporary financial hardship and

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

with costs; and

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

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

anticipated;

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

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

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

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

intervention;

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

treatment;

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

residence in accordance with terms of the resident contract;

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

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

accessible lockable space provided for security of small personal valuables;

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

nutritional and special medical dietary needs;

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

well being;

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

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

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

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

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

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

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

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

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

guardian.

SECTION 3. Section 23-17.16-2 of the General Laws in Chapter 23-17.16 entitled

"Home Care Patient Rights" is hereby amended to read as follows:

23-17.16-2. Rights of home care patients/clients. -- Each home care patient/client has

the following rights:

(1) To receive services without regard to race, creed, color, gender, sexual orientation,

age, disability, or source of payment.

(2) To receive safe, appropriate and high quality care and services in a timely manner

with consideration, dignity, respect and privacy.

(3) To accept or refuse care and to be informed of the consequences of that action.

(4) To be free from mental or physical abuse, physical punishment, neglect, damage to or

theft of property, or exploitation of any kind.

(5) To have his or her property treated with respect.

(6) To exercise his or her rights as a patient/client of the home nursing care provider or

home care provider agency. When the patient/client is unable to exercise his or her rights, an

agent or legal guardian may exercise the patient's/client's rights.

(7) To be informed, in advance, about the care to be furnished (and not to be furnished),

the plan of care, and of any changes in the care to be furnished before the change is made.

(8) To help plan the care and services received or to help change the care and services.

(9) To be advised in advance of the disciplines that will furnish care, the frequency of

visits proposed to be furnished, and the names and qualifications of all individuals providing care.

(10) To receive information necessary to make decisions about care (or to have a family

member receive that information, as appropriate) and to have access to their records.

(11) To receive information and counseling about advanced directives such as the living

will and durable power of attorney for health care, to formulate advanced directives, and to

receive written information about the policy of the home nursing care provider or home care

provider agency on client advanced directives and state COMFORT ONE protocol.

(12) To have his or her personal and clinical records treated and maintained in a

confidential manner and to be advised by the agency of its policies and procedures regarding

disclosure of clinical records.

(13) To be advised, before care is initiated, if the provider is a full participating provider

in the patient's/client's health care plan, the cost of services, the extent to which payment for the

home nursing care provider or home care provider agency services may be expected from

insurance, government and other sources, and the extent to which payment may be required from

the patient/client and the charges they will be required to pay.

(14) To be informed of the home nursing care provider or home care provider agency's

billing procedures and the patient/client payment responsibilities.

(15) To be informed of the home nursing care provider or home care provider agency's

ownership and control.

(16) To be informed of any experimental research or investigational activities and the

right to refuse them.

(17) To voice grievances (or to have the patient's/client's family or guardian voice

grievances on the patient's/client's behalf if the patient/client is unable to do so) regarding

treatment or care that is (or fails to be) furnished, or regarding the lack of respect for property by

anyone who is furnishing services on behalf of the home nursing care provider or home care

provider agency; to be advised on how to voice grievances; and not to be subjected to

discrimination or reprisal for doing so.

(18) To have the patient's/client's complaints investigated, or complaints made by the

patient's/client's family or guardian, regarding treatment or care that is (or fails to be) furnished,

or regarding the lack of respect for the patient/client or the patient's/client's property by anyone

furnishing services on behalf of the home nursing care provider or home care provider agency,

and the home nursing care provider or home care provider agency must document both the

existence of the complaint and the resolution of the complaint.

(19) To be informed, in writing, of his or her rights to appeal a determination or decision

made by the home nursing care provider or home care provider agency with regard to eligibility

for service, the types or levels of service in the care plan, a termination or change in service, or if

the patient/client feels that his or her rights under this chapter have been violated.

(20) To be advised, in writing, of the names, addresses, and telephone numbers of the

state ombudsperson, the attorney general's Medicaid fraud control unit, the state licensing agency

and the availability of the state toll-free home health hotline, the hours of its operation, and that

the purpose of the hotline is to receive complaints or questions about local home nursing care

providers or home care providers.

(21) The patient/client shall have the right to receive information concerning hospice

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

SECTION 4. Chapter 23-17.5 of the General Laws entitled "Rights of Nursing Home

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

23-17.5-29. Hospice. – Upon request, the patient shall have the right to receive

information concerning hospice care, including the benefits of hospice care, the cost, and how to

enroll in hospice care.

SECTION 5. This act shall take effect on July 1, 2004.

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LC02111/SUB A

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