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HB-4606, As Passed Senate, February 15, 2006

SUBSTITUTE FOR

HOUSE BILL NO. 4606

A bill to amend 1978 PA 368, entitled

"Public health code,"

by amending section 20201 (MCL 333.20201), as amended by 2001 PA

240.

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

Sec. 20201. (1) A health facility or agency that provides

services directly to patients or residents and is licensed under

this article shall adopt a policy describing the rights and

responsibilities of patients or residents admitted to the health

facility or agency. Except for a licensed health maintenance

organization which shall comply with chapter 35 of the insurance

code of 1956, 1956 PA 218, MCL 500.3501 to 500.3580, the policy

shall be posted at a public place in the health facility or agency

and shall be provided to each member of the health facility or

agency staff. Patients or residents shall be treated in accordance

with the policy.

(2) The policy describing the rights and responsibilities of

patients or residents required under subsection (1) shall include,

as a minimum, all of the following:

(a) A patient or resident shall not be denied appropriate care

on the basis of race, religion, color, national origin, sex, age,

disability, marital status, sexual preference, or source of

payment.

(b) An individual who is or has been a patient or resident is

entitled to inspect, or receive for a reasonable fee, a copy of his

or her medical record upon request in accordance with the medical

records access act, 2004 PA 47, MCL 333.26261 to 333.26271. A

Except as otherwise permitted or required under the health

insurance portability and accountability act of 1996, Public Law

104-191, or regulations promulgated under that act, 45 CFR parts

160 and 164, a third party shall not be given a copy of the

patient's or resident's medical record without prior authorization

of the patient or resident.

treatment of personal and medical records, and may refuse their

release to a person outside the health facility or agency except as

required because of a transfer to another health care facility, or

as required by law or third party payment contract, or as permitted

or required under the health insurance portability and

accountability act of 1996, Public Law 104-191, or regulations

promulgated under that act, 45 CFR parts 160 and 164.

(d) A patient or resident is entitled to privacy, to the

extent feasible, in treatment and in caring for personal needs with

consideration, respect, and full recognition of his or her dignity

and individuality.

(e) A patient or resident is entitled to receive adequate and

appropriate care, and to receive, from the appropriate individual

within the health facility or agency, information about his or her

medical condition, proposed course of treatment, and prospects for

recovery, in terms that the patient or resident can understand,

unless medically contraindicated as documented by the attending

physician in the medical record.

(f) A patient or resident is entitled to refuse treatment to

the extent provided by law and to be informed of the consequences

of that refusal. If a refusal of treatment prevents a health

facility or agency or its staff from providing appropriate care

according to ethical and professional standards, the relationship

with the patient or resident may be terminated upon reasonable

notice.

(g) A patient or resident is entitled to exercise his or her

rights as a patient or resident and as a citizen, and to this end

may present grievances or recommend changes in policies and

services on behalf of himself or herself or others to the health

facility or agency staff, to governmental officials, or to another

person of his or her choice within or outside the health facility

or agency, free from restraint, interference, coercion,

discrimination, or reprisal. A patient or resident is entitled to

information about the health facility's or agency's policies and

procedures for initiation, review, and resolution of patient or

resident complaints.

(h) A patient or resident is entitled to information

concerning an experimental procedure proposed as a part of his or

her care and has the right to refuse to participate in the

experimental procedure without jeopardizing his or her continuing

care.

(i) A patient or resident is entitled to receive and examine

an explanation of his or her bill regardless of the source of

payment and to receive, upon request, information relating to

financial assistance available through the health facility or

agency.

(j) A patient or resident is entitled to know who is

responsible for and who is providing his or her direct care, is

entitled to receive information concerning his or her continuing

health needs and alternatives for meeting those needs, and to be

involved in his or her discharge planning, if appropriate.

(k) A patient or resident is entitled to associate and have

private communications and consultations with his or her physician,

attorney, or any other person of his or her choice and to send and

receive personal mail unopened on the same day it is received at

the health facility or agency, unless medically contraindicated as

documented by the attending physician in the medical record. A

patient's or resident's civil and religious liberties, including

the right to independent personal decisions and the right to

knowledge of available choices, shall not be infringed and the

health facility or agency shall encourage and assist in the fullest

possible exercise of these rights. A patient or resident may meet

with, and participate in, the activities of social, religious, and

community groups at his or her discretion, unless medically

contraindicated as documented by the attending physician in the

medical record.

(l) A patient or resident is entitled to be free from mental

and physical abuse and from physical and chemical restraints,

except those restraints authorized in writing by the attending

physician for a specified and limited time or as are necessitated

by an emergency to protect the patient or resident from injury to

self or others, in which case the restraint may only be applied by

a qualified professional who shall set forth in writing the

circumstances requiring the use of restraints and who shall

promptly report the action to the attending physician. In case of a

chemical restraint, a physician shall be consulted within 24 hours

after the commencement of the chemical restraint.

(m) A patient or resident is entitled to be free from

performing services for the health facility or agency that are not

included for therapeutic purposes in the plan of care.

(n) A patient or resident is entitled to information about the

health facility or agency rules and regulations affecting patient

or resident care and conduct.

(o) A patient or resident is entitled to adequate and

appropriate pain and symptom management as a basic and essential

element of his or her medical treatment.

(3) The following additional requirements for the policy

described in subsection (2) apply to licensees under parts 213 and

217:

(a) The policy shall be provided to each nursing home patient

or home for the aged resident upon admission, and the staff of the

facility shall be trained and involved in the implementation of the

policy.

(b) Each nursing home patient may associate and communicate

privately with persons of his or her choice. Reasonable, regular

visiting hours, which shall be not less than 8 hours per day, and

which shall take into consideration the special circumstances of

each visitor, shall be established for patients to receive

visitors. A patient may be visited by the patient's attorney or by

representatives of the departments named in section 20156, during

other than established visiting hours. Reasonable privacy shall be

afforded for visitation of a patient who shares a room with another

patient. Each patient shall have reasonable access to a telephone.

A married nursing home patient or home for the aged resident is

entitled to meet privately with his or her spouse in a room that

assures privacy. If both spouses are residents in the same

facility, they are entitled to share a room unless medically

contraindicated and documented by the attending physician in the

medical record.

entitled to retain and use personal clothing and possessions as

space permits, unless to do so would infringe upon the rights of

other patients or residents, or unless medically contraindicated as

documented by the attending physician in the medical record. Each

nursing home patient or home for the aged resident shall be

provided with reasonable space. At the request of a patient, a

nursing home shall provide for the safekeeping of personal effects,

funds, and other property of a patient in accordance with section

21767, except that a nursing home is not required to provide for

the safekeeping of a property that would impose an unreasonable

burden on the nursing home.

(d) A nursing home patient or home for the aged resident is

entitled to the opportunity to participate in the planning of his

or her medical treatment. A nursing home patient shall be fully

informed by the attending physician of the patient's medical

condition unless medically contraindicated as documented by a

physician in the medical record. Each nursing home patient shall be

afforded the opportunity to discharge himself or herself from the

nursing home.

(e) A home for the aged resident may be transferred or

discharged only for medical reasons, for his or her welfare or that

of other residents, or for nonpayment of his or her stay, except as

provided by title XVIII or title XIX. A nursing home patient may be

transferred or discharged only as provided in sections 21773 to

21777. A nursing home patient or home for the aged resident is

entitled to be given reasonable advance notice to ensure orderly

transfer or discharge. Those actions shall be documented in the

medical record.

(f) A nursing home patient or home for the aged resident is

entitled to be fully informed before or at the time of admission

and during stay of services available in the facility, and of the

related charges including any charges for services not covered

under title XVIII, or not covered by the facility's basic per diem

rate. The statement of services provided by the facility shall be

in writing and shall include those required to be offered on an as-

needed basis.

(g) A nursing home patient or home for the aged resident is

entitled to manage his or her own financial affairs, or to have at

least a quarterly accounting of personal financial transactions

undertaken in his or her behalf by the facility during a period of

time the patient or resident has delegated those responsibilities

to the facility. In addition, a patient or resident is entitled to

receive each month from the facility an itemized statement setting

forth the services paid for by or on behalf of the patient and the

services rendered by the facility. The admission of a patient to a

nursing home does not confer on the nursing home or its owner,

administrator, employees, or representatives the authority to

manage, use, or dispose of a patient's property.

(h) A nursing home patient or a person authorized by the

patient in writing may inspect and copy the patient's personal and

medical records. The records shall be made available for inspection

and copying by the nursing home within a reasonable time, not

exceeding 1 week, after the receipt of a written request.

(i) If a nursing home patient desires treatment by a licensed

member of the healing arts, the treatment shall be made available

unless it is medically contraindicated, and the medical

contraindication is justified in the patient's medical record by

the attending physician.

(j) A nursing home patient has the right to have his or her

parents, if a minor, or his or her spouse, next of kin, or

patient's representative, if an adult, stay at the facility 24

hours a day if the patient is considered terminally ill by the

physician responsible for the patient's care.

(k) Each nursing home patient shall be provided with meals

that meet the recommended dietary allowances for that patient's age

and sex and that may be modified according to special dietary needs

or ability to chew.

(l) Each nursing home patient has the right to receive

representatives of approved organizations as provided in section

21763.

(4) A nursing home, its owner, administrator, employee, or

representative shall not discharge, harass, or retaliate or

discriminate against a patient because the patient has exercised a

right protected under this section.

(5) In the case of a nursing home patient, the rights

enumerated in subsection (2)(c), (g), and (k) and subsection

(3)(d), (g), and (h) may be exercised by the patient's

representative.

(6) A nursing home patient or home for the aged resident is

entitled to be fully informed, as evidenced by the patient's or

resident's written acknowledgment, before or at the time of

admission and during stay, of the policy required by this section.

The policy shall provide that if a patient or resident is

adjudicated incompetent and not restored to legal capacity, the

rights and responsibilities set forth in this section shall be

exercised by a person designated by the patient or resident. The

health facility or agency shall provide proper forms for the

patient or resident to provide for the designation of this person

at the time of admission.

(7) This section does not prohibit a health facility or agency

from establishing and recognizing additional patients' rights.

(8) As used in this section:

(a) "Patient's representative" means that term as defined in

section 21703.

(b) "Title XVIII" means title XVIII of the social security

act, ~~chapter 531, 49 Stat. 620, 42 U.S.C. 1395 to 1395b, 1395b-2,~~

~~1395b-6 to 1395b-7, 1395c to 1395i, 1395i-2 to 1395i-5, 1395j to~~

~~1395t, 1395u to 1395w, 1395w-2 to 1395w-4, 1395w-21 to 1395w-28,~~

~~1395x to 1395yy, and 1395bbb to 1395ggg~~ 42 USC 1395 to 1395hhh.

~~chapter 531, 49 Stat. 620, 42 U.S.C. 1396 to 1396f, 1396g-1 to~~

~~1396r-6, and 1396r-8~~ 42 USC 1396 to 1396v.