Revision: March 27, 2014, midnight
SB 213-FN – AS AMENDED BY THE SENATE
1/30/14 0149s
2014 SESSION
01/04
SENATE BILL 213-FN
AN ACT establishing a registry for physician orders for life-sustaining treatment.
SPONSORS: Sen. Reagan, Dist 17; Sen. Fuller Clark, Dist 21; Sen. Bradley, Dist 3; Sen. Carson, Dist 14; Sen. Cataldo, Dist 6; Sen. Gilmour, Dist 12; Sen. Larsen, Dist 15; Sen. Lasky, Dist 13; Sen. Odell, Dist 8; Sen. Soucy, Dist 18; Sen. Watters, Dist 4; Rep. Suzanne Smith, Graf 8; Rep. Kotowski, Merr 24
COMMITTEE: Health, Education and Human Services
This bill establishes the New Hampshire POLST Registry Act. Under this bill, a patient may execute a form to be signed by the patient and his or her physician relative to life-sustaining treatment to ensure that the patient’s preferences are known in the event of an emergency.
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Explanation: Matter added to current law appears in bold italics.
Matter removed from current law appears [in brackets and struckthrough.]
Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
1/30/14 0149s
14-2616
01/04
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Fourteen
AN ACT establishing a registry for physician orders for life-sustaining treatment.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 New Chapter; New Hampshire POLST Registry Act. Amend RSA by inserting after chapter 137-K the following new chapter:
CHAPTER 137-L
NEW HAMPSHIRE POLST REGISTRY ACT
137-L:1 Short Title. This chapter shall be known as the “New Hampshire POLST Registry Act.”
137-L:2 Definitions. In this chapter:
I. “Authorized user” means a person authorized by the department to provide information to or receive information from the POLST registry.
II. “Commissioner” means the commissioner of the department of health and human services.
III. “Department” means the department of health and human services.
IV. “Advance practice registered nurse” means an advance practice registered nurse licensed under RSA 326-B.
V. “Physician” means a physician licensed under RSA 329.
VI. “Physician assistant” means a physician assistant licensed under RSA 328-D.
VII. “POLST” means a provider order for life-sustaining treatment signed by a physician, advance practice registered nurse, or physician assistant.
VIII. “POLST registry” means the registry established in RSA 137-L:3.
137-L:3 POLST Registry Established; Rulemaking.
I. The department shall establish and operate a statewide registry for the collection and dissemination of physician orders for life-sustaining treatment to help ensure that medical treatment preferences for an individual nearing the end of his or her life are honored.
II. The commissioner shall adopt rules, pursuant to RSA 541-A relative to:
(a) Requiring submission of the following documents to the registry, unless the patient has requested to opt out of the registry:
(1) A copy of each POLST;
(2) A copy of a revised POLST; and
(3) Notice of any known revocation of a POLST;
(b) Prescribing the manner for submitting the information described in subparagraph (a);
(c) Requiring the release of registry information to authorized users for treatment purposes;
(d) Authorizing notification by the registry to specified persons of the receipt, revision, or revocation of a POLST; and
(e) Establishing procedures to protect the accuracy and confidentiality of information submitted to the registry.
III. The department may permit qualified researchers to access registry data. If the department permits qualified researchers to have access to registry data, the department shall adopt rules, pursuant to RSA 541-A, governing the access to data that shall include but not be limited to:
(a) The definition of a qualified researcher.
(b) The process for a qualified researcher to request access to registry data;
(c) The types of data that a qualified researcher may be provided from the registry; and
(d) The manner by which a researcher shall protect registry data obtained under this provision.
IV. The department may contract with a private or public entity to establish or maintain the registry.
137-L:4 Application of Chapter to Department. Nothing in this chapter shall require the department to:
I. Prescribe the form or content of a POLST;
II. Disseminate forms to be used for a POLST;
III. Educate the public about POLSTs; or
IV. Train health care providers about POLSTs.
137-L:5 POLST Registry Advisory Committee.
I. There is hereby established the New Hampshire POLST registry advisory committee to advise the commissioner regarding the implementation, operation, and evaluation of the POLST registry. The advisory committee shall be appointed by the commissioner and shall include, at a minimum:
(a) A health professional with extensive experience and leadership in POLST issues.
(b) A physician who has worked with emergency medical services providers and who has extensive experience in POLST issues.
(c) A representative from the hospital community with extensive experience in POLST issues.
(d) A representative from the long-term care community with extensive experience in POLST issues.
(e) A representative from the hospice community with extensive experience in POLST issues.
(f) An emergency medical services provider actively involved in providing emergency medical services.
(g) Two members of the public with active interest in end-of-life treatment preferences, at least one of whom represents the interests of minorities.
(h) The director of the division of fire standards and training and emergency medical services, or designee, shall serve as a voting ex officio member of the committee.
II. Except for the director of the division of fire standards and training and emergency medical services or designee, the term of office of each member shall be 3 years and until a successor is appointed and qualified. Initial members of the committee under subparagraphs I(a)-(g) shall serve staggered terms. Vacancies shall be filled in the same manner and for the unexpired terms. The council shall meet as necessary but at least 4 times per year at a time and place specified by the commissioner. Four members of the committee shall constitute a quorum. The department shall provide necessary staff support to the committee.
III. The commissioner shall consult with the committee in drafting rules required under this chapter.
137-L:6 Application of Chapter. Nothing in this chapter shall be construed to require an individual to have a POLST or to require a health professional to authorize or execute a POLST. A POLST may be revoked at any time by the patient.
137-L:7 Confidentiality. Except as provided in RSA 137-L:3, all information collected or developed by the POLST registry that identifies or could be used to identify a patient, or health care provider or facility shall be confidential and shall not be subject to civil or administrative subpoena or to discovery, in a civil action, including but not limited to a judicial, administrative, arbitration, or mediation proceeding.
137-L:8 Immunity. Any person reporting information to the POLST registry or acting on information obtained from the POLST registry in good faith shall be immune from any civil or criminal liability that might otherwise be incurred or imposed with respect to the reporting of information to the POLST registry or acting on information obtained from the POLST registry.
2 Effective Date. This act shall take effect 60 days after its passage.
LBAO
14-2616
Amended 02/04/14
SB 213-FN FISCAL NOTE
AN ACT establishing a registry for physician orders for life-sustaining treatment.
FISCAL IMPACT:
The Department of Health and Human Services states this bill, as amended by the Senate (Amendment #2014-0149s), will increase state expenditures and revenue by an indeterminable amount in FY 2015 and each year thereafter. There will be no fiscal impact on county or local revenues and expenditures.
METHODOLOGY:
The Department of Health and Human Services states this bill would require the Department to establish and operate a statewide registry to collect and disseminate physicians orders for life-sustaining treatment (POLST), grant rulemaking authority to the commissioner concerning operation of the POLST registry, and require the commissioner to appoint members to the POLST advisory committee established in the bill. The Department indicates it would explore whether there are federal or private funds are available to help fund the registry. The Department assumes it would integrate the POLST registry into New Hampshire Helps, an internet-based emergency assistance registry currently in development for use by the DHHS. In estimating initial utilization of the POLST registry, the Department relied on a Journal of the American Medical Association article from January 2012 about a similar registry in the state of Oregon. Based on this information and New Hampshire census information, the Department estimates a utilization rate of 8,834 by the end of the first year. The Department estimated the following costs assuming a July 1, 2014 effective date:
FY 2015 |
FY 2016 |
FY 2017 |
FY 2018 | |
Supervisor - Program Specialist IV, Labor Grade 25: |
$45,435 |
$47,424 |
$49,511 |
$51,695 |
Research Analyst - Research & Data Coordinator, Labor Grade 23: |
$41,711 |
$43,485 |
$45,435 |
$47,424 |
Program Specialist I - Part-time Educational Outreach Specialist, Labor Grade 19: |
$17,697 |
$18,418 |
$19,218 |
$19,998 |
Data Processing Supervisor I - Part-time, Labor Grade 15: |
$15,084 |
$15,727 |
$16,361 |
$17,024 |
Total Salaries: |
$119,927 |
$125,054 |
$130,525 |
$136,141 |
Full and Part-time benefits: |
$54,534 |
$57,643 |
$60,956 |
$64,471 |
Salaries and Benefits: |
$174,461 |
$182,697 |
$191,481 |
$200,612 |
Other Costs |
? |
? |
? |
? |
Current Expense Supplies, telephone, postage, etc.: |
$15,000 |
$15,000 |
$15,000 |
$15,000 |
Equipment (one-time costs): |
$4,500 |
$0 |
$0 |
$0 |
In-State Travel: |
$3,000 |
$3,000 |
$3,000 |
$3,000 |
Integration of POLST into New Hampshire Helps: |
$40,000 |
$0 |
$0 |
$0 |
Annual IT support and maintenance: |
$12,000 |
$12,000 |
$12,000 |
$12,000 |
Subtotal Other Costs |
$74,500 |
$30,000 |
$30,000 |
$30,000 |
Total Costs |
$248,961 |
$212,697 |
$221,481 |
$230,612 |
The Department expects there will be additional costs for staff and program support in future years based on outreach and marketing of the POLST registry and on actual utilization. The additional operating costs for FY 2016 through FY 2018 are not known.