Chapter 111 of the General Laws is hereby amended by adding the following section:-

Section 233. (a) As used in this section, the following words shall have the following meanings, unless the context clearly requires otherwise:

“Hospital”, a facility licensed under section 51.

“After-care”, assistance provided by a caregiver to a patient after the patient’s discharge from a hospital; provided, however, that such assistance may include, but is not limited to, assisting with basic activities of daily living, instrumental activities of daily living or carrying out medical or nursing tasks, such as managing wound care, assisting in administering medications and operating medical equipment.

“Caregiver”, an individual duly designated as a caregiver by a patient who provides after-care assistance to a patient living in the patient’s residence which may, but shall not be limited to, include a relative, partner, friend, or neighbor who has a significant relationship with the patient.

“Discharge”, a patient’s exit or release from a hospital to the patient’s residence following an inpatient admission.

“Entry”, a patient’s admission into a hospital for medical care.

“Residence”, a dwelling that the patient considers to be home; provided, however, that a “residence” shall not include a rehabilitation facility, hospital, nursing home, or assisted living facility.

(b) A hospital shall provide each patient or, if applicable, the patient’s legal guardian an opportunity to designate at least 1 caregiver under this section not later than 24 hours after the patient’s entry into a hospital and prior to the patient’s discharge or transfer to another facility.  In the event that the patient is unconscious or otherwise incapacitated upon the patient’s entry into the hospital, the hospital shall provide the patient or the patient’s legal guardian with an opportunity to designate a caregiver within 24 hours following the patient’s recovery of consciousness or capacity.  If the patient or the patient’s legal guardian declines to designate a caregiver under the Act, the hospital shall promptly document that decision in the patient’s medical record.

If the patient or the patient’s legal guardian designates an individual as a caregiver under this section, the hospital shall: (i) promptly request the written consent of the patient or the patient’s legal guardian to release medical information to the patient’s designated caregiver following the hospital’s established procedures for releasing personal health information and in compliance with all federal and state laws; and (ii) record the patient’s designation of a caregiver, the relationship of the designated caregiver to the patient and the name, telephone number and address of the patient’s designated caregiver in the patient’s medical record.  If the patient or the patient’s legal guardian declines to consent to the release medical information to the patient’s designated caregiver, the hospital shall not provide notice to the caregiver under subsection (c) or provide information contained in the patient’s discharge plan under subsection (d).

A patient may elect to change a designated caregiver at any time and the hospital shall record this change in the patient’s medical record within 24 hours.

A designation of a caregiver by a patient or a patient’s legal guardian under this Section does not obligate any individual to perform any after-care tasks for any patient.  This section shall not be construed to require a patient or a patient’s legal guardian to designate any individual as a caregiver under this section.             

(c) A hospital shall notify the patient’s designated caregiver of the patient’s discharge or transfer to another hospital or facility licensed under section 51 as soon as possible.  Such notice may be given after the patient’s physician issues a discharge order, shall not be later than 4 hours prior to the patient’s actual discharge or transfer to another hospital or facility.

(d) As soon as possible and not later than 24 hours prior to a patient’s discharge from a hospital, the hospital shall consult with the designated caregiver along with the patient regarding the caregiver’s capabilities and limitations.  The hospital shall issue a discharge plan that describes a patient’s after-care needs at the patient’s residence.  A discharge plan shall include, but shall not be limited to: (i) the name and contact information of the caregiver designated under this section;  (ii) a description of all after-care tasks necessary to maintain the patient’s ability to reside at home, taking into account the capabilities and limitations of the caregiver; and (iii) the contact information for any health care, community resources and long-term services and supports necessary to successfully carry out the patient’s discharge plan.

The hospital issuing the discharge plan must provide caregivers with instruction in all after-care tasks described in the discharge plan.  The instruction shall include, but shall not be limited to: (i) a live demonstration of the tasks performed by a hospital employee or individual with whom the hospital has a contractual relationship authorized to perform the after-care task, provided in a culturally competent manner and in accordance with the hospital’s requirements to provide language access services under state and federal law; (ii) an opportunity for the caregiver and patient to ask questions about the after-care tasks; and (iii) answers to the caregiver’s and patient’s questions provided in a culturally competent manner and in accordance with the hospital’s requirements to provide language access services under state and federal law.  Instruction required under this subsection shall be documented in the patient’s medical record and shall include, but shall not be limited to, the date, time and contents of the instruction.

(e)  The department of public health may promulgate regulations to implement this section, including, but not limited to, regulations to further define the content and scope of any instruction provided to caregivers under subsection (d).

(f)  Nothing in this section shall be construed to interfere with the rights of an agent operating under a valid health care proxy established under chapter 201D.