CHAPTER 151 RESIDENTIAL CARE AND HEALTH FACILITY LICENSING
Patients' Bill of Rights
Section 151:26-a
151:26-a Discharge of Home Health Care Clients. –
I. Except as provided in paragraph IV, a home health care provider shall provide a minimum of 14 days notice of the intent to discharge a client.
II. Written notice of discharge shall be provided to the client or the client's legal representative and included in the client's clinical record. A copy of the notice of discharge shall be provided to the ordering physician or authorizing health care provider, if any, and the case manager, if any. At a minimum, the notice shall include the following:
(a) The reason for the discharge.
(b) The effective date of the discharge.
(c) The identity of and contact information for the service provider, if any, who is or will be taking on the care of the client.
(d) The steps the client should take to reinstate services, if any.
(e) The telephone number and contact information for the state and federal home health care regulatory agency.
(f) The following statement in bold type: "You have a right to appeal the decision to discharge you from home health care services. If you think you should not be discharged, you or your legal representative may request an expedited administrative hearing from the New Hampshire Department of Health and Human Services or you may file an appeal in superior or probate court. You also may register a complaint with the state and federal home health care regulatory agencies. If you have a legal representative that person may act on your behalf."
III. (a) A home health care provider may discharge a client if the client's needs can no longer be met by the home health care provider, if one or more of the following applies:
(1)(A) The client or the client's legal representative, the client's family, persons residing with the client, or the client's informal supports are non-compliant with or interfere with implementation of the plan of care and the scope and effect of the non-compliance or interference:
(i) Has led to or will lead to an immediate deterioration in the client's condition, such that home health care will no longer be safe or appropriate; or
(ii) Has made attainment of reasonable therapeutic goals at home impossible.
(B) In addition, the likely outcome of the non-compliance or interference has been explained to the client or the client's legal representative, to the client's informal supports, and to the case manager, if applicable, and the client continues to refuse to comply with, or others continue to interfere with, the implementation of the plan of care.
(2) The availability of home health care or community support services is no longer sufficient to meet the client's changing care needs.
(3) The home health care provider personnel with the required qualifications who were providing the client's care are no longer employed by the home health care provider and no other qualified personnel is or is expected to be available.
(b) The home health care provider shall make reasonable attempts, prior to discharge, to resolve the circumstances that may lead to a discharge under this paragraph. When a home health care provider determines that a client will require continuing care after services are discontinued pursuant to this paragraph, the home health care provider shall arrange for or assist the client to arrange for such services, to the extent practicable, and shall provide sufficient clinical information to the receiving entity to assure continuity of care and services. The home health care provider shall educate the patient on how to obtain further care, treatment, and services to meet his or her identified needs, as necessary.
IV. (a) A home health care provider may provide notice of discharge to a client in less than 14 days if:
(1) The client requests services be discontinued or the client moves out of the service area.
(2) An emergency discharge is mandated by the client's health care needs and is in accordance with written orders of the client's ordering physician or authorizing health care provider, if any.
(3) The client no longer needs the services provided by the home health care provider, as confirmed by the client's ordering physician, authorizing health care provider, or case manager, as appropriate.
(4) Conditions in or around the home imminently threaten the safety of the home health care provider personnel or jeopardize the home health care provider's ability to provide care, in accordance with paragraph V.
(5) The client, the client's government payor, or the client's third-party payor ceases payment or denies authorization for further care and the client is unable or unwilling to pay for continued services or unwilling to apply for other available resources.
(b) No discharge shall be permitted if it is contrary to RSA 151:21-b or to the requirements of Titles XVIII or XIX of the Social Security Act, as applicable. The provider shall give notice of the discharge allowed under this paragraph, as soon as practicable.
V. Conditions in or around the home imminently threaten the safety of the home health care provider personnel or jeopardize the home health care provider's ability to provide care in the following situations:
(a) Conditions are known to exist in or around the home that would imminently threaten the safety of personnel, including but not limited to:
(1) Actual or probable physical assault.
(2) Continuing severe verbal threats which the individual making the threats has the ability to carry out and which create a reasonable concern for personal safety.
(3) Other circumstances that are likely to cause serious injury.
(b) The home health care provider has valid reason to believe that its personnel will be subjected to continuing and severe verbal abuse or sexual harassment, as defined in RSA 354-A:7, V, which will jeopardize the home health care provider's ability to secure sufficient personnel resources or to provide care that meets the needs of the client.
VI. A home health care provider that intends to discharge a client shall:
(a) Prepare a discharge plan designed to ensure a timely and safe discharge in consultation with the client or the client's legal representative, the client's ordering physician or other authorizing health care provider, if any, and any other professional involved in the plan of care, such as a case manager.
(b) In the event of an immediate discharge:
(1) Take appropriate measures to ensure client safety, including immediate notification of the client or the client's legal representative, the client's physician or other authorizing health care provider, if any, and other agencies known by the home health care provider to be involved in the provision of home health care services, including a case manager.
(2) If appropriate, make a report to adult protective services, in accordance with RSA 161-F, or to child protective services, in accordance with RSA 169-C, or to law enforcement authorities indicating the client's ongoing care needs and the reason for discharge.
(3) Provide written notification in accordance with paragraph II within 5 calendar days of the discharge.
VII. (a) A client of a home health care provider subject to discharge under this section may appeal to the department of health and human services or to the superior or probate court.
(b) The commissioner of the department of health and human services shall adopt rules, pursuant to RSA 541-A, relative to the proper conduct of administrative appeals under this paragraph.