NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A1323B
SPONSOR: Rosenthal (MS)
TITLE OF BILL: An act to amend the public health law, in relation to
identification of caregivers
This bill would require a general hospital as defined in § 2801(10) of
the public health law to allow a patient an opportunity to designate,
upon admission to a hospital, a caregiver in the patient's medical
record; to require a hospital to notify and offer to meet with the
designated caregiver to discuss the patient's plan of care prior to the
patient's discharge or transfer to another facility; to require a hospi-
tal to offer to adequately train the designated caregiver in certain
aftercare tasks upon a patient's discharge to his or her current resi-
SUMMARY OF PROVISIONS:
Section 1 adds a new section 29-CCCC to the public health law and sets
Section 2 sets forth the effective date.
At any given time, an estimated 4.1 million New Yorkers provide varying
degrees of unreimbursed care to adults with limitations in daily activ-
ities. The total value of the unpaid care provided to individuals in
need of long-term services and supports amounts to an estimated $32
billion every year, based on 2009 data. Caregivers are often members of
the individual's immediate family, but friends and other community
members also serve as caregivers. While most caregivers are asked to
assist an individual with basic activities of daily living, such as
mobility, eating, and dressing, many are expected to perform complex
tasks on a daily basis such as administering multiple medications,
providing wound care, and operating medical equipment.
Despite the vast importance of caregivers in the individual's day-to-day
care, many caregivers find that they are often left out of discussions
involving a patient's care while in the hospital and, upon the patient's
discharge, receive little to no instruction on the tasks they are
expected to perform. The federal Centers for Medicare & Medicaid
Services (CMS) estimates that $17 billion in Medicare funds is spent
each year on unnecessary hospital readmissions. Additionally, hospitals
desire to avoid the imposition of new readmission penalties under the
federal Patient Protection and Affordable Care Act (ACA).
In order to successfully address the challenges of a surging population
of older adults and others who have significant needs for long-term
services and supports, the state must develop methods to enable caregiv-
ers to continue to support their loved ones at home and in the communi-
ty, and avoid costly hospital readmissions. Therefore, it is the intent
of the New York State Assembly that this Act enables caregivers to
provide competent post-hospital care to their family and other loved
ones, at minimal cost to the taxpayers of this State.
A.9816 of 2014
This act shall take effect immediately.
STATE OF NEW YORK
2015-2016 Regular Sessions
January 9, 2015
Introduced by M. of A. ROSENTHAL, LUPARDO, CLARK, ROBERTS, GALEF,
STIRPE, DINOWITZ, SKOUFIS, GUNTHER, BRAUNSTEIN, JAFFEE, RAIA, LINARES,
FAHY, BRINDISI, BRONSON, WOERNER, McDONALD, LAVINE, STECK, WALKER,
CURRAN, BARRETT, WOZNIAK, TITONE, PERRY, MAYER, KEARNS, COLTON,
RIVERA, WEPRIN, PALUMBO, COOK, ZEBROWSKI, SANTABARBARA -- Multi-Spon-
sored by -- M. of A. CYMBROWITZ, LUPINACCI, McDONOUGH, PAULIN,
PEOPLES-STOKES, RA, TENNEY, THIELE, WALTER, WRIGHT -- read once and
referred to the Committee on Health -- committee discharged, bill
amended, ordered reprinted as amended and recommitted to said commit-
tee -- reported and referred to the Committee on Codes -- committee
discharged, bill amended, ordered reprinted as amended and recommitted
to said committee
AN ACT to amend the public health law, in relation to identification of
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. The public health law is amended by adding a new article
2 29-CCCC to read as follows:
3 ARTICLE 29-CCCC
4 CARE ACT (CAREGIVER ADVISE, RECORD AND ENABLE ACT)
5 Section 2994-hh. Short title.
6 2994-ii. Definitions.
7 2994-jj. Caregiver; opportunity to identify.
8 2994-kk. Notice to identified caregiver.
9 2994-ll. Instruction to identified caregiver.
10 2994-mm. Effect on other rights.
11 § 2994-hh. Short title. This article shall be known and may be cited
12 as the "CARE act".
13 § 2994-ii. Definitions. When used in this article, the following
14 words or phrases shall have the following meanings:
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
 is old law to be omitted.
A. 1323--B 2
1 1. "Hospital" shall mean any "general hospital" as defined in section
2 twenty-eight hundred one of this chapter.
3 2. "After-care" shall mean any assistance provided by a caregiver to a
4 patient under this article after the patient's discharge from a hospital
5 that is related to the patient's condition at the time of discharge.
6 Such assistance shall include, but is not limited to, assisting with
7 basic activities of daily living (ADLs), instrumental activities of
8 daily living (IADLs), and other tasks as determined to be appropriate by
9 the discharging physician.
10 3. "Caregiver" shall mean any individual duly identified as a caregiv-
11 er by a patient under this article who provides after-care assistance to
12 a patient living in his or her residence. An identified caregiver shall
13 include, but is not limited to, a relative, partner, friend or neighbor
14 who has a significant relationship with the patient.
15 4. "Discharge" shall mean a patient's exit or release from a hospital
16 to the patient's residence following an inpatient admission.
17 5. "Entry" shall mean a patient's admission into a hospital for the
18 purposes of receiving inpatient care.
19 6. "Patient" shall mean a patient eighteen years of age or older.
20 7. "Residence" shall mean a dwelling that the patient considers to be
21 his or her home. A "residence" for the purposes of this article shall
22 not include any rehabilitation facility, hospital, nursing home,
23 assisted living facility, group home or other residential health care
24 facility as defined in section twenty-eight hundred one of this chapter
25 or any inpatient facility regulated by the office of mental health.
26 § 2994-jj. Caregiver; opportunity to identify. 1. A hospital shall
27 provide each patient or, if applicable, the patient's legal guardian
28 with at least one opportunity to identify at least one caregiver under
29 this article following the patient's entry into a hospital and prior to
30 the patient's discharge or transfer to another facility. The hospital
31 shall inform the patient that the purpose of providing the caregiver's
32 identity is to include that caregiver in discharge planning and sharing
33 of post-discharge care information or instruction.
34 (a) In the event that the patient is unconscious or otherwise incapac-
35 itated upon his or her entry into a hospital, the hospital shall provide
36 such patient or his/her legal guardian with an opportunity to identify a
37 caregiver following the patient's recovery of his or her consciousness
38 or capacity.
39 (b) In the event that the patient or the patient's legal guardian
40 declines to identify a caregiver under this article, the hospital shall
41 promptly document this in the patient's medical record.
42 (c) The hospital shall record the patient's identification of a care-
43 giver if given by the patient or legal guardian, the relationship of the
44 identified caregiver to the patient, and the name, telephone number, and
45 address of the patient's identified caregiver in the patient's medical
47 (d) A patient may elect to change his or her identified caregiver at
48 any time, and the hospital must record this change in the patient's
49 medical record.
50 (e) (i) The hospital shall promptly request the written consent of the
51 patient or the patient's legal guardian to release medical information
52 to the patient's designated caregiver following the hospital's estab-
53 lished procedure for releasing personal health information and in
54 compliance with all state and federal laws, including the federal Health
55 Insurance Portability and Accountability Act of 1996 as amended, and
56 related regulations.
A. 1323--B 3
1 (ii) If the patient or the patient's legal guardian declines to
2 consent to release medical information to the patient's designated care-
3 giver, the hospital shall not be required to provide notice to the care-
4 giver under section twenty-nine hundred ninety-four-kk of this article
5 or provide information contained in the patient's discharge plan under
6 section twenty-nine hundred ninety-four-ll of this article.
7 2. An identification of a caregiver by a patient or a patient's legal
8 guardian under this section does not obligate any individual to perform
9 any after-care tasks for any patient.
10 3. This section shall not be construed to require a patient or a
11 patient's legal guardian to identify any individual as a caregiver as
12 defined by this article.
13 § 2994-kk. Notice to identified caregiver. A hospital shall notify the
14 patient's identified caregiver of the patient's discharge or transfer to
15 another hospital or facility licensed by the department or the office of
16 mental health as soon as the date and time of discharge or transfer can
17 be anticipated prior to the patient's actual discharge or transfer to
18 such facility. In the event the hospital is unable to contact the
19 designated caregiver, the lack of contact shall not interfere with,
20 delay, or otherwise affect the medical care provided to the patient or
21 an appropriate discharge of the patient. The hospital shall promptly
22 document the attempt in the patient's medical record.
23 § 2994-ll. Instruction to identified caregiver. 1. As soon as possi-
24 ble and not later than twenty-four hours prior to a patient's discharge
25 from a hospital, the hospital shall consult with the identified caregiv-
26 er along with the patient regarding the caregiver's capabilities and
27 limitations and issue a discharge plan that describes a patient's
28 after-care needs at his or her residence. In the event the hospital is
29 unable to contact the designated caregiver, the lack of contact shall
30 not interfere with, delay, or otherwise affect the medical care provided
31 to the patient or an appropriate discharge of the patient. The hospital
32 shall promptly document the attempt in the patient's medical record. At
33 minimum, a discharge plan shall include:
34 (a) the name and contact information of the caregiver identified under
35 this article;
36 (b) a description of all after-care tasks recommended by the discharg-
37 ing physician, taking into account the capabilities and limitations of
38 the caregiver; and
39 (c) contact information for health care, community resources, and
40 long-term services and supports necessary to successfully carry out the
41 patient's discharge plan.
42 2. The hospital issuing the discharge plan must offer caregivers with
43 instruction in all after-care tasks described in the discharge plan.
44 (a) At minimum, such instruction shall include:
45 (i) a live or recorded demonstration of the tasks performed by a
46 hospital employee authorized to perform the after-care task, provided in
47 a culturally competent manner and in accordance with the hospital's
48 requirements to provide language access services under state and federal
50 (ii) an opportunity for the caregiver and patient to ask questions
51 about the after-care tasks; and
52 (iii) answers to the caregiver's and patient's questions provided in a
53 culturally competent manner and in accordance with the hospital's
54 requirements to provide language access services under state and federal
A. 1323--B 4
1 (b) Any instructions required under this article shall be documented
2 in the patient's medical record, including, at minimum, the date, time,
3 and contents of the instruction.
4 3. The department is authorized to promulgate regulations to implement
5 the provisions of this article, including but not limited to, regu-
6 lations to further define the content and scope of any instruction
7 provided to caregivers under this article.
8 § 2994-mm. Effect on other rights. 1. Nothing in this article shall be
9 construed to interfere with the rights of an agent operating under a
10 valid health care directive created under section twenty-nine hundred
11 eighty-two of this chapter.
12 2. Nothing in this article shall be construed to create a new private
13 right of action not otherwise existing in law against a hospital or any
14 of its directors, trustees, officers, employees or agents, or any
15 contractors with whom a hospital has a contractual relationship.
16 3. A hospital, any of its directors, trustees, officers, employees or
17 agents, or any contractors with whom a hospital has a contractual
18 relationship shall not be held liable, provided it has complied with
19 this article and acted reasonably and in good faith, for the services
20 rendered or not rendered by the caregiver to the patient at the
21 patient's residence.
22 § 2. This act shall take effect on the one hundred eightieth day after
23 it shall have become a law.