Text to be removed highlighted in red.
1 Short Title. Section 2 of this act shall be known as "Grace's Law".
2 New Section; Services for the Developmentally Disabled; Right to Preferred Method of Communication. Amend RSA 171-A by inserting after section 4 the following new section:
171-A:4-a Right to Preferred Method of Communication.
I. An individual with a communication disability who is receiving services under this chapter shall have the right to select and utilize their preferred method of communication that enables such individual to independently express their own thoughts and wishes. Methods of communication that may enable an individual to independently express themselves include, but are not limited to, any of the following methods:
(a) Augmentative and Alternative Communication (AAC) techniques and devices.
(b) Independent use of letterboards and independent typing-based communication.
(c) Sign language and non-verbal gestural systems.
(d) Speech-generating devices or any other assistive technology.
II. Every school, day, residential and other program or service provider involved in the implementation of the individual's individualized education program or the individual's service agreement shall make all reasonable efforts to accommodate an individual's preferred method of communication, including securing necessary training to communicate with the individual using the individual's preferred method of communication.
3 Purpose. The purpose of section 4 this act is to protect patient safety and continuity of care by ensuring that transfers from freestanding hospital emergency facilities are based on clinical appropriateness, patient needs, and regional access to hospital services. Section 4 of this act further seeks to prevent practices that may undermine community hospitals through coercive or exclusive transfer arrangements that are not clinically justified.
4 New Subdivision; Transfers from Freestanding Hospital Emergency Facilities. Amend RSA 151 by inserting after section 53 the following new subdivision:
Transfers from Freestanding Hospital Emergency Facilities
151:54 Definitions. In this subdivision:
I. "Freestanding hospital emergency facility" or "FHEF" means a facility licensed under this chapter that is geographically separate from an acute care hospital and provides emergency medical services on behalf of, or in affiliation with, a parent hospital.
II. "Parent hospital" means an acute care hospital that owns, controls, or operates a freestanding hospital emergency facility, directly or indirectly.
III. "Clinically appropriate" means consistent with the judgment of the treating physician, the patient's medical condition, and applicable regional emergency medical services protocols.
IV. "Transfer" means the movement of a patient from a freestanding hospital emergency facility to another licensed hospital or health care facility for the purpose of providing continued medical care, and shall not include discharge to home or referral for non-emergent outpatient services.
V. "Medically necessary" means determined by the treating physician or qualified practitioner to be required to prevent or address a material deterioration of the patient's medical condition, consistent with applicable standards of care.
151:55 Transfer Standards.
I. When a transfer from a freestanding hospital emergency facility to an acute care hospital is medically necessary, the facility shall ensure that transfer decisions are based primarily on clinical appropriateness, patient safety, continuity of care, and patient choice.
II. A patient, or the patient's legal representative when applicable, shall be informed of available receiving hospitals that are clinically appropriate and reasonably available, provided that such discussion does not delay screening, stabilization, or transfer required under federal law.
III. No freestanding hospital emergency facility shall require or condition treatment, stabilization, or transfer upon selection of a receiving hospital based primarily on ownership or affiliation.
IV. If a patient is unable to participate in the selection of a receiving hospital, the facility shall arrange transfer to an appropriate hospital consistent with:
(a) RSA 153-A:1 and RSA 151:19, VII;
(b) State-designated trauma, stroke, or specialty care systems;
(c) Federal and state law governing emergency medical treatment and transfer; and
(d) The patient's medical condition and safety.
151:56 Prohibited Practices.
I. No freestanding hospital emergency facility, nor any entity owning or operating such facility, shall:
(a) Engage in materially misleading communication or coercive conduct for the primary purpose of directing patient transfers to an affiliated or parent hospital when another clinically appropriate hospital is reasonably available.
(b) Condition transfer decisions on insurance status or payer considerations.
(c) Enter into exclusive transfer arrangements with emergency medical services providers that require patient transfers to an affiliated hospital without regard to clinical appropriateness, patient needs, patient choice, or regional emergency medical services protocols.
II. Nothing in this section shall prohibit non-exclusive coordination agreements with emergency medical services providers for quality assurance, response efficiency, or specialty care, provided such agreements do not require exclusive routing based on ownership affiliation.
151:57 Federal Law EMTALA. Nothing in this subdivision shall be construed to alter, expand, or restrict obligations under the federal Emergency Medical Treatment and Labor Act (EMTALA), 42 U.S.C. section 1395dd. Compliance with EMTALA shall be deemed compliance with this subdivision. In the event of a conflict, federal law shall control.
151:58 Enforcement; Rulemaking.
I. The attorney general may adopt rules under RSA 541-A to define and implement enforcement standards under this subdivision, including but not limited to defining what constitutes a pattern of violations, coercive conduct, or materially misleading communication.
II. Upon a finding of a pattern of violations as defined by rule, the attorney general may pursue enforcement under RSA 358-A.
III. Prior to referral for enforcement, the department of health and human services shall provide notice of alleged violations and a reasonable opportunity to cure.
151:59 Scope. This subdivision applies only to transfers occurring prior to inpatient admission at the receiving hospital and shall not regulate post-admission referral, discharge planning, or elective admission decisions.
5 Effective Date.
I. Sections 1 and 2 of this act shall take effect 60 days after its passage.
II. The remainder of this act shall take effect upon its passage.
Text to be added highlighted in green.
1 Short Title. Section 2 of this act shall be known as "Grace's Law".
2 New Section; Services for the Developmentally Disabled; Right to Preferred Method of Communication. Amend RSA 171-A by inserting after section 4 the following new section:
171-A:4-a Right to Preferred Method of Communication.
I. An individual with a communication disability who is receiving services under this chapter shall have the right to select and utilize their preferred method of communication that enables such individual to independently express their own thoughts and wishes. Methods of communication that may enable an individual to independently express themselves include, but are not limited to, any of the following methods:
(a) Augmentative and Alternative Communication (AAC) techniques and devices.
(b) Independent use of letterboards and independent typing-based communication.
(c) Sign language and non-verbal gestural systems.
(d) Speech-generating devices or any other assistive technology.
II. Every school, day, residential and other program or service provider involved in the implementation of the individual's individualized education program or the individual's service agreement shall make all reasonable efforts to accommodate an individual's preferred method of communication, including securing necessary training to communicate with the individual using the individual's preferred method of communication.
3 Purpose. The purpose of section 4 this act is to protect patient safety and continuity of care by ensuring that transfers from freestanding hospital emergency facilities are based on clinical appropriateness, patient needs, and regional access to hospital services. Section 4 of this act further seeks to prevent practices that may undermine community hospitals through coercive or exclusive transfer arrangements that are not clinically justified.
4 New Subdivision; Transfers from Freestanding Hospital Emergency Facilities. Amend RSA 151 by inserting after section 53 the following new subdivision:
Transfers from Freestanding Hospital Emergency Facilities
151:54 Definitions. In this subdivision:
I. "Freestanding hospital emergency facility" or "FHEF" means a facility licensed under this chapter that is geographically separate from an acute care hospital and provides emergency medical services on behalf of, or in affiliation with, a parent hospital.
II. "Parent hospital" means an acute care hospital that owns, controls, or operates a freestanding hospital emergency facility, directly or indirectly.
III. "Clinically appropriate" means consistent with the judgment of the treating physician, the patient's medical condition, and applicable regional emergency medical services protocols.
IV. "Transfer" means the movement of a patient from a freestanding hospital emergency facility to another licensed hospital or health care facility for the purpose of providing continued medical care, and shall not include discharge to home or referral for non-emergent outpatient services.
V. "Medically necessary" means determined by the treating physician or qualified practitioner to be required to prevent or address a material deterioration of the patient's medical condition, consistent with applicable standards of care.
151:55 Transfer Standards.
I. When a transfer from a freestanding hospital emergency facility to an acute care hospital is medically necessary, the facility shall ensure that transfer decisions are based primarily on clinical appropriateness, patient safety, continuity of care, and patient choice.
II. A patient, or the patient's legal representative when applicable, shall be informed of available receiving hospitals that are clinically appropriate and reasonably available, provided that such discussion does not delay screening, stabilization, or transfer required under federal law.
III. No freestanding hospital emergency facility shall require or condition treatment, stabilization, or transfer upon selection of a receiving hospital based primarily on ownership or affiliation.
IV. If a patient is unable to participate in the selection of a receiving hospital, the facility shall arrange transfer to an appropriate hospital consistent with:
(a) RSA 153-A:1 and RSA 151:19, VII;
(b) State-designated trauma, stroke, or specialty care systems;
(c) Federal and state law governing emergency medical treatment and transfer; and
(d) The patient's medical condition and safety.
151:56 Prohibited Practices.
I. No freestanding hospital emergency facility, nor any entity owning or operating such facility, shall:
(a) Engage in materially misleading communication or coercive conduct for the primary purpose of directing patient transfers to an affiliated or parent hospital when another clinically appropriate hospital is reasonably available.
(b) Condition transfer decisions on insurance status or payer considerations.
(c) Enter into exclusive transfer arrangements with emergency medical services providers that require patient transfers to an affiliated hospital without regard to clinical appropriateness, patient needs, patient choice, or regional emergency medical services protocols.
II. Nothing in this section shall prohibit non-exclusive coordination agreements with emergency medical services providers for quality assurance, response efficiency, or specialty care, provided such agreements do not require exclusive routing based on ownership affiliation.
151:57 Federal Law EMTALA. Nothing in this subdivision shall be construed to alter, expand, or restrict obligations under the federal Emergency Medical Treatment and Labor Act (EMTALA), 42 U.S.C. section 1395dd. Compliance with EMTALA shall be deemed compliance with this subdivision. In the event of a conflict, federal law shall control.
151:58 Enforcement; Rulemaking.
I. The attorney general may adopt rules under RSA 541-A to define and implement enforcement standards under this subdivision, including but not limited to defining what constitutes a pattern of violations, coercive conduct, or materially misleading communication.
II. Upon a finding of a pattern of violations as defined by rule, the attorney general may pursue enforcement under RSA 358-A.
III. Prior to referral for enforcement, the department of health and human services shall provide notice of alleged violations and a reasonable opportunity to cure.
151:59 Scope. This subdivision applies only to transfers occurring prior to inpatient admission at the receiving hospital and shall not regulate post-admission referral, discharge planning, or elective admission decisions.
5 Effective Date.
I. Sections 1 and 2 of this act shall take effect 60 days after its passage.
II. The remainder of this act shall take effect upon its passage.