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House Bill No. 5479

PUBLIC ACT NO. 96-81

AN ACT IMPLEMENTING THE NURSING HOME TASK FORCE RECOMMENDATIONS.

Be it enacted by the Senate and House of Representatives in General Assembly convened:

Section 1. Section 19a-550 of the general statutes, as amended by sections 12 and 21 of public act 95-257, is repealed and the following is substituted in lieu thereof:

(a) As used in this section, a "nursing home facility" is as defined in section 19a-521, AS AMENDED [and] a "chronic disease hospital" means a long-term hospital having facilities, medical staff and all necessary personnel for the diagnosis, care and treatment of chronic diseases AND FOR THE PURPOSES OF SUBSECTIONS (c) AND (d) OF THIS SECTION, AND SUBSECTION (b) OF SECTION 19a-537, AS AMENDED BY SECTION 2 OF THIS ACT, "MEDICALLY CONTRAINDICATED" MEANS A COMPREHENSIVE EVALUATION OF THE IMPACT OF A POTENTIAL ROOM TRANSFER ON THE PATIENT'S PHYSICAL, MENTAL AND PSYCHOSOCIAL WELL-BEING, WHICH DETERMINES THAT THE TRANSFER WOULD CAUSE NEW SYMPTOMS OR EXACERBATE PRESENT SYMPTOMS BEYOND A REASONABLE ADJUSTMENT PERIOD RESULTING IN A PROLONGED OR SIGNIFICANT NEGATIVE OUTCOME THAT COULD NOT BE AMELIORATED THROUGH CARE PLAN INTERVENTION, AS DOCUMENTED BY A PHYSICIAN IN A PATIENT'S MEDICAL RECORD.

(b) There is established a patients' bill of rights for any person admitted as a patient to any nursing home facility or chronic disease hospital. The patients' bill of rights shall be implemented in accordance with the provisions of Sections 1919(c)(2), 1919(c)(2)(D) and 1919(c)(2)(E) of the Social Security Act. Said patients' bill of rights shall provide that each such patient: (1) Is fully informed, as evidenced by his written acknowledgment, prior to or at the time of admission and during his stay, of these rights and of all rules and regulations governing patient conduct and responsibilities; (2) is fully informed, prior to or at the time of admission and during his stay, of services available in the facility, and of related charges including any charges for services not covered under Titles XVIII or XIX of the Social Security Act, or not covered by basic per diem rate; (3) is entitled to choose his own physician and is fully informed, by a physician, of his medical condition unless medically contraindicated, as documented by the physician in his medical record, and is afforded the opportunity to participate in the planning of his medical treatment and to refuse to participate in experimental research; (4) IN A HOME FOR THE AGED OR A CHRONIC DISEASE HOSPITAL is transferred from one room to another within the facility only for medical reasons, or for his welfare or that of other patients, as documented in his medical record and such record shall include documentation of action taken to minimize any disruptive effects of such transfer, except a patient who is a Medicaid recipient may be transferred from a private room to a non-private room, provided no patient may be involuntarily transferred from one room to another within the facility if (A) it is medically established that the move will subject the patient to a reasonable likelihood of serious physical injury or harm or (B) the patient has a prior established medical history of psychiatric problems and there is psychiatric testimony that as a consequence of the proposed move there will be exacerbation of the psychiatric problem which would last over a significant period of time and require psychiatric intervention; and in the case of an involuntary transfer from one room to another within the facility, the patient and, if known, his legally liable relative, guardian or conservator, is given at least thirty days' and no more than sixty days' written notice to ensure orderly transfer from one room to another within the facility, except where the health, safety or welfare of other patients is endangered or where immediate transfer from one room to another within the facility is necessitated by urgent medical need of the patient or where a patient has resided in the facility for less than thirty days, in which case notice shall be given as many days before the transfer as practicable; (5) is encouraged and assisted, throughout his period of stay, to exercise his rights as a patient and as a citizen, and to this end may voice grievances and recommend changes in policies and services to facility staff or to outside representatives of his choice, free from restraint, interference, coercion, discrimination or reprisal; (6) shall have prompt efforts made by the facility to resolve grievances the patient may have, including those with respect to the behavior of other patients; (7) may manage his personal financial affairs, and is given a quarterly accounting of financial transactions made on his behalf; (8) is free from mental and physical abuse, corporal punishment, involuntary seclusion and any physical or chemical restraints imposed for purposes of discipline or convenience and not required to treat the patient's medical symptoms. Physical or chemical restraints may be imposed only to ensure the physical safety of the patient or other patients and only upon the written order of a physician that specifies the type of restraint and the duration and circumstances under which the restraints are to be used, except in emergencies until a specific order can be obtained; (9) is assured confidential treatment of his personal and medical records, and may approve or refuse their release to any individual outside the facility, except in case of his transfer to another health care institution or as required by law or third-party payment contract; (10) receives services with reasonable accommodation of individual needs and preferences, except where the health or safety of the individual would be endangered, and is treated with consideration, respect, and full recognition of his dignity and individuality, including privacy in treatment and in care for his personal needs; (11) is not required to perform services for the facility that are not included for therapeutic purposes in his plan of care; (12) may associate and communicate privately with persons of his choice, including other patients, send and receive his personal mail unopened and make and receive telephone calls privately, unless medically contraindicated, as documented by his physician in his medical record, and receives adequate notice before his room or his roommate in the facility is changed; (13) is entitled to organize and participate in patient groups in the facility and to participate in social, religious and community activities that do not interfere with the rights of other patients, unless medically contraindicated, as documented by his physician in his medical records; (14) may retain and use his personal clothing and possessions unless to do so would infringe upon rights of other patients or unless medically contraindicated, as documented by his physician in his medical record; (15) if married, is assured privacy for visits by his spouse and if both are inpatients in the facility, they are permitted to share a room, unless medically contraindicated, as documented by the attending physician in the medical record; (16) is fully informed of the availability of and may examine all current state, local and federal inspection reports and plans of correction; (17) may organize, maintain and participate in a patient-run resident council, as a means of fostering communication among residents and between residents and staff, encouraging resident independence and addressing the basic rights of nursing home and chronic disease hospital patients and residents, free from administrative interference or reprisal; (18) is entitled to the opinion of two physicians concerning the need for surgery, except in an emergency situation, prior to such surgery being performed; (19) is entitled to have the patient's family meet in the facility with the families of other patients in the facility to the extent the facility has existing meeting space available which meets applicable building and fire codes; (20) is entitled to file a complaint with the state department of social services and the state department of public health and addiction services regarding patient abuse, neglect or misappropriation of patient property; (21) is entitled to have psychopharmacologic drugs administered only on orders of a physician and only as part of a written plan of care designed to eliminate or modify the symptoms for which the drugs are prescribed and only if, at least annually, an independent external consultant reviews the appropriateness of the drug plan; (22) is entitled to be transferred or discharged from the facility only pursuant to section 19a-535, AS AMENDED, or section 19a-535b, AS AMENDED, as applicable; (23) is entitled to be treated equally with other patients with regard to transfer, discharge and the provision of all services regardless of the source of payment; (24) shall not be required to waive any rights to benefits under Medicare or Medicaid or to give oral or written assurance that he is not eligible for, or will not apply for benefits under Medicare or Medicaid; (25) is entitled to be provided information by the facility as to how to apply for Medicare or Medicaid benefits and how to receive refunds for previous payments covered by such benefits; (26) on or after October 1, 1990, shall not be required to give a third party guarantee of payment to the facility as a condition of admission to, or continued stay in, the facility; (27) in the case of an individual who is entitled to medical assistance, is entitled to have the facility not charge, solicit, accept, or receive, in addition to any amount otherwise required to be paid under Medicaid, any gift, money, donation or other consideration as a precondition of admission or expediting the admission of the individual to the facility or as a requirement for the individual's continued stay in the facility; and (28) shall not be required to deposit his personal funds in the facility.

(c )THE PATIENTS' BILL OF RIGHTS SHALL PROVIDE THAT A PATIENT IN A REST HOME WITH NURSING SUPERVISION OR A CHRONIC AND CONVALESCENT NURSING HOME MAY BE TRANSFERRED FROM ONE ROOM TO ANOTHER WITHIN A FACILITY ONLY FOR THE PURPOSE OF PROMOTING THE PATIENT'S WELL-BEING, EXCEPT AS PROVIDED PURSUANT TO SUBPARAGRAPH (C) OR (D) OF THIS SUBSECTION OR SUBSECTION (d) OF THIS SECTION. WHENEVER A PATIENT IS TO BE TRANSFERRED THE FACILITY SHALL EFFECT THE TRANSFER WITH THE LEAST DISRUPTION TO THE PATIENT AND SHALL ASSESS, MONITOR AND ADJUST CARE AS NEEDED SUBSEQUENT TO THE TRANSFER IN ACCORDANCE WITH SUBDIVISION (10) OF SUBSECTION (b) OF THIS SECTION. WHEN A TRANSFER IS INITIATED BY THE FACILITY AND THE PATIENT DOES NOT CONSENT TO THE TRANSFER, THE FACILITY SHALL ESTABLISH A CONSULTATIVE PROCESS THAT INCLUDES THE PARTICIPATION OF THE ATTENDING PHYSICIAN, A REGISTERED NURSE WITH RESPONSIBILITY FOR THE PATIENT, OTHER APPROPRIATE STAFF IN DISCIPLINES AS DETERMINED BY THE PATIENT'S NEEDS, AND THE PARTICIPATION OF THE PATIENT, HIS FAMILY OR OTHER REPRESENTATIVE. THE CONSULTATIVE PROCESS SHALL DETERMINE (1) WHAT CAUSED CONSIDERATION OF THE TRANSFER; (2) WHETHER THE CAUSE CAN BE REMOVED; AND (3) IF NOT, WHETHER THE FACILITY HAS ATTEMPTED ALTERNATIVES TO TRANSFER. THE PATIENT SHALL BE INFORMED OF THE RISKS AND BENEFITS OF THE TRANSFER AND OF ANY ALTERNATIVES. IF SUBSEQUENT TO THE COMPLETION OF THE CONSULTATIVE PROCESS A PATIENT STILL DOES NOT WISH TO BE TRANSFERRED, THE PATIENT MAY BE TRANSFERRED WITHOUT HIS CONSENT, UNLESS MEDICALLY CONTRAINDICATED, ONLY (A) IF NECESSARY TO ACCOMPLISH PHYSICAL PLANT REPAIRS OR RENOVATIONS THAT OTHERWISE COULD NOT BE ACCOMPLISHED; PROVIDED, IF PRACTICABLE, THE PATIENT, IF HE WISHES, SHALL BE RETURNED TO HIS ROOM WHEN THE REPAIRS OR RENOVATIONS ARE COMPLETED; (B) DUE TO IRRECONCILABLE INCOMPATIBILITY BETWEEN OR AMONG ROOMMATES, WHICH IS ACTUALLY OR POTENTIALLY HARMFUL TO THE WELL-BEING OF A PATIENT; (C) IF THE FACILITY HAS TWO VACANCIES AVAILABLE FOR PATIENTS OF THE SAME SEX IN DIFFERENT ROOMS, THERE IS NO APPLICANT OF THAT SEX PENDING ADMISSION IN ACCORDANCE WITH THE REQUIREMENTS OF SECTION 19a-533, AS AMENDED, AND GROUPING OF PATIENTS BY THE SAME SEX IN THE SAME ROOM WOULD ALLOW ADMISSION OF PATIENTS OF THE OPPOSITE SEX, WHICH OTHERWISE WOULD NOT BE POSSIBLE; (D) IF NECESSARY TO ALLOW ACCESS TO SPECIALIZED MEDICAL EQUIPMENT NO LONGER NEEDED BY THE PATIENT AND NEEDED BY ANOTHER PATIENT; OR (E) IF THE PATIENT NO LONGER NEEDS THE SPECIALIZED SERVICES OR PROGRAMMING THAT IS THE FOCUS OF THE AREA OF THE FACILITY IN WHICH THE PATIENT IS LOCATED. IN THE CASE OF AN INVOLUNTARY TRANSFER, THE FACILITY SHALL, SUBSEQUENT TO COMPLETION OF THE CONSULTATIVE PROCESS, PROVIDE THE PATIENT AND HIS LEGALLY LIABLE RELATIVE, GUARDIAN OR CONSERVATOR IF ANY OR OTHER RESPONSIBLE PARTY IF KNOWN, WITH AT LEAST FIFTEEN DAYS WRITTEN NOTICE OF THE TRANSFER, WHICH SHALL INCLUDE THE REASON FOR THE TRANSFER, THE LOCATION TO WHICH THE PATIENT IS BEING TRANSFERRED, AND THE NAME, ADDRESS AND TELEPHONE NUMBER OF THE REGIONAL LONG-TERM CARE OMBUDSMAN, EXCEPT THAT IN THE CASE OF A TRANSFER PURSUANT TO SUBPARAGRAPH (A) OF THIS SUBSECTION AT LEAST THIRTY DAYS SUCH NOTICE SHALL BE PROVIDED. NOTWITHSTANDING THE PROVISIONS OF THIS SUBSECTION, A PATIENT MAY BE INVOLUNTARILY TRANSFERRED IMMEDIATELY FROM ONE ROOM TO ANOTHER WITHIN A FACILITY TO PROTECT HIMSELF OR OTHERS FROM PHYSICAL HARM; TO CONTROL THE SPREAD OF AN INFECTIOUS DISEASE; TO RESPOND TO A PHYSICAL PLANT OR ENVIRONMENTAL EMERGENCY THAT THREATENS THE PATIENT'S HEALTH OR SAFETY; OR TO RESPOND TO A SITUATION THAT PRESENTS A PATIENT WITH AN IMMEDIATE DANGER OF DEATH OR SERIOUS PHYSICAL HARM. IN SUCH A CASE, DISRUPTION OF PATIENTS SHALL BE MINIMIZED; THE REQUIRED NOTICE SHALL BE PROVIDED WITHIN TWENTY-FOUR HOURS AFTER THE TRANSFER; IF PRACTICABLE, THE PATIENT, IF HE WISHES, SHALL BE RETURNED TO HIS ROOM WHEN THE THREAT TO HEALTH OR SAFETY WHICH PROMPTED THE TRANSFER HAS BEEN ELIMINATED; AND, IN THE CASE OF A TRANSFER EFFECTED TO PROTECT A PATIENT OR OTHERS FROM PHYSICAL HARM, THE CONSULTATIVE PROCESS SHALL BE ESTABLISHED ON THE NEXT BUSINESS DAY.

(d) NOTWITHSTANDING THE PROVISIONS OF SUBSECTION (c) OF THIS SECTION, UNLESS MEDICALLY CONTRAINDICATED, A PATIENT WHO IS A MEDICAID RECIPIENT MAY BE TRANSFERRED FROM A PRIVATE TO A NONPRIVATE ROOM. IN THE CASE OF SUCH A TRANSFER, THE FACILITY SHALL (1) GIVE AT LEAST THIRTY DAYS WRITTEN NOTICE TO THE PATIENT AND HIS LEGALLY LIABLE RELATIVE, GUARDIAN OR CONSERVATOR, IF ANY, OR OTHER RESPONSIBLE PARTY, IF KNOWN, WHICH NOTICE SHALL INCLUDE THE REASON FOR THE TRANSFER, THE LOCATION TO WHICH THE PATIENT IS BEING TRANSFERRED AND THE NAME, ADDRESS AND TELEPHONE NUMBER OF THE REGIONAL LONG-TERM CARE OMBUDSMAN; AND (2) ESTABLISH A CONSULTATIVE PROCESS TO EFFECT THE TRANSFER WITH THE LEAST DISRUPTION TO THE PATIENT AND ASSESS, MONITOR AND ADJUST CARE AS NEEDED SUBSEQUENT TO THE TRANSFER IN ACCORDANCE WITH SUBDIVISION (10) OF SUBSECTION (b) OF THIS SECTION. THE CONSULTATIVE PROCESS SHALL INCLUDE THE PARTICIPATION OF THE ATTENDING PHYSICIAN, A REGISTERED NURSE WITH RESPONSIBILITY FOR THE PATIENT, OTHER APPROPRIATE STAFF IN DISCIPLINES AS DETERMINED BY THE PATIENT'S NEEDS, AND, THE PARTICIPATION OF THE PATIENT, HIS FAMILY OR OTHER REPRESENTATIVE.

[(c)] (e) Any facility that negligently deprives a patient of any right or benefit created or established for the well-being of the patient by the provisions of this section shall be liable to such patient in a private cause of action for injuries suffered as a result of such deprivation. Upon a finding that a patient has been deprived of such a right or benefit, and that the patient has been injured as a result of such deprivation, damages shall be assessed in the amount sufficient to compensate such patient for such injury. In addition, where the deprivation of any such right or benefit is found to have been willful or in reckless disregard of the rights of the patient, punitive damages may be assessed. A patient may also maintain an action pursuant to this section for any other type of relief, including injunctive and declaratory relief, permitted by law. Exhaustion of any available administrative remedies shall not be required prior to commencement of suit under this section.

[(d)] (f) In addition to the rights specified in subsections (b)[and] (c) AND (d), a patient in a nursing home facility is entitled to have the facility manage his or her funds as provided in section 19a-551 AS AMENDED.

Sec. 2. Subsection (b) of section 19a-537 of the general statutes, as amended by section 3 of public act 95-160, is repealed and the following is substituted in lieu thereof:

(b) A nursing home shall: (1) Reserve the bed of a self-pay resident of such facility who is absent from the facility due to hospitalization whenever payment is available to reserve the bed; (2) Inform the self-pay resident and his relatives or other responsible persons, upon admission of a person to the facility and upon transfer of a resident to a hospital, that the bed of a resident will be reserved as long as payment is available to the facility to reserve the bed and that if payment is not made, the resident will be admitted to the next available bed; (3) Reserve the bed of a resident who is a recipient of medical assistance when the resident is absent from the facility for home leave days authorized under the Medicaid program; (4) Inform the resident who is a recipient of medical assistance and his relatives or other responsible persons, upon admission of a person to the nursing home and upon transfer of a resident to a hospital of the conditions under which the Department of Social Services requires the nursing home to reserve the bed of a resident and that if the home is not required to reserve the bed, the resident will be admitted to the next available bed; and (5) Not make the bed reserved for a hospitalized resident available for use by any other person unless the nursing home records in such resident's medical record the medical [or administrative] reasons justifying the change in such resident's bed, AND THE NECESSITY OF MAKING THE CHANGE BEFORE THE RESIDENT'S RETURN TO THE FACILITY provided no resident's bed shall be changed if [the medical director of the nursing home, in consultation with the treating physician, reasonably anticipates that such change would result in serious medical harm to the resident] (A) SUCH A CHANGE IS MEDICALLY CONTRAINDICATED AS DEFINED IN SUBSECTION (a) OF SECTION 19a-550, AS AMENDED BY SECTION 1 OF THIS ACT; OR (B) IF THE RESIDENT DOES NOT CONSENT TO THE CHANGE, EXCEPT WHEN THE CHANGE IS MADE (i) TO PROTECT THE RESIDENT OR OTHERS FROM PHYSICAL HARM; (ii) TO CONTROL THE SPREAD OF AN INFECTIOUS DISEASE; OR (iii) TO RESPOND TO A PHYSICAL PLANT OR ENVIRONMENTAL EMERGENCY THAT THREATENS THE RESIDENT'S HEALTH OR SAFETY. IN THE CASE OF SUCH AN INVOLUNTARY CHANGE OF A RESIDENT'S BED, DISRUPTION OF RESIDENTS SHALL BE MINIMIZED, NOTICE SHALL BE PROVIDED TO THE RESIDENT OR REPRESENTATIVE WITHIN TWENTY-FOUR HOURS AFTER THE CHANGE AND, IF PRACTICABLE, THE RESIDENT, IF HE WISHES, SHALL BE RETURNED TO HIS ROOM WHEN THE THREAT TO HEALTH OR SAFETY WHICH PROMPTED THE TRANSFER HAS BEEN ELIMINATED. WHEN A RESIDENT'S BED IS CHANGED WITHOUT HIS CONSENT TO PROTECT THE RESIDENT OR OTHERS FROM PHYSICAL HARM, A CONSULTATIVE PROCESS SHALL BE ESTABLISHED ON THE FIRST BUSINESS DAY FOLLOWING THE RESIDENT'S RETURN TO THE FACILITY. THE CONSULTATIVE PROCESS SHALL INCLUDE THE PARTICIPATION OF THE ATTENDING PHYSICIAN, A REGISTERED NURSE WITH RESPONSIBILITY FOR THE RESIDENT, OTHER APPROPRIATE STAFF IN DISCIPLINES AS DETERMINED BY THE RESIDENT'S NEEDS AND THE PARTICIPATION OF THE RESIDENT, HIS FAMILY OR OTHER REPRESENTATIVE. THE CONSULTATIVE PROCESS SHALL DETERMINE WHAT CAUSED THE CHANGE IN BED, WHETHER THE CAUSE CAN BE REMOVED AND, IF NOT, WHETHER THE FACILITY HAS ATTEMPTED ALTERNATIVES TO THE CHANGE. THE RESIDENT SHALL BE INFORMED OF THE RISKS AND BENEFITS OF THE CHANGE IN BED AND OF ANY ALTERNATIVES.

Approved May 8, 1996. Effective October 1, 1996.

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