Current through Register Vol. 46, No. 39, September 25, 2024
(a)
General.
(1) The governing body
shall establish and implement written admission and discharge policies to
protect the health and safety of the patients and shall not assign or delegate
the functions of admission and discharge to any referral agency and shall not
permit the splitting or sharing of fees between a referring agency and the
hospital.
(b)
Admission.
(1) Each patient
shall be advised of their rights pursuant to section
405.7 of this Part and, as
appropriate, the criteria for Medicaid eligibility.
(2) No person shall be denied admission to
the hospital because of race, creed, national origin, sex, disability within
the capacity of the hospital to provide treatment, sexual orientation or source
of payment.
(3) Except in
emergencies, patients shall be admitted only upon referral and under the care
of a licensed and currently registered practitioner who is granted admitting
privileges by the governing body. The patient's condition and provisional
diagnosis shall be established on admission by the patient's admitting
practitioner and shall be noted in the patient's medical record.
(4) Except in emergencies, a hospital shall
admit as patients only those persons who require the type of medical services
authorized by the hospital's operating certificate.
(5) Except as provided in section
405.2(f)(4) of
this Part, the hospital shall have a licensed and currently registered
physician, or a registered physician's assistant under the general supervision
of a physician, or a nurse practitioner in collaberation with a physician,
available on the premises at all times who shall be responsible for receiving
patients for care in accordance with policies established by the hospital and
for the appropriate disposition of requests to admit patients.
(6) Insofar as it is practicable, the
admitting practitioner shall request of each person being admitted, information
concerning signs or symptoms of recent exposure to communicable diseases as
defined in Part 2 of this Title. Whenever there are positive findings of
exposure to such communicable disease, the patient shall be isolated and
managed in accordance with the hospital's infection control policies and the
provisions of Part 2 of this Title.
(7) Pediatrics.
(i) The hospital shall admit pediatric
patients consistent with its ability to provide qualified staff, space and size
appropriate equipment necessary for the unique needs of pediatric patients. The
hospital shall establish a separate pediatric unit if the hospital regularly
has 16 or more pediatric patients at one time or if pediatric patients cannot
be adequately and safely cared for in other than separately certified pediatric
beds. If a hospital cannot meet these requirements the hospital must develop
criteria and policies and procedures for transfer of pediatric
patients.
(ii) Hospitals
maintaining certified pediatric beds shall assure that admission to those beds
is limited to patients who have not yet reached their 21st birthday except in
instances when there are no other available beds within the hospital. In such
instances, the hospital shall afford priority admission to the pediatric bed to
patients 20 years of age or younger.
(iii) Children under the age of 14 shall not
be admitted to a room with patients 21 years of age or over except with the
knowledge and agreement of the child's attending practitioner and parent or
guardian and the concurrence of the other patients occupying the room and their
attending practitioners.
(iv) In
the event a separate unit is not available, arrangements for the admission of
all children shall be made consistent with written policies and procedures to
ensure the safety of each patient.
(v) The hospital shall develop policies and
procedures enabling parents/guardians to stay with pediatric patients. To the
extent possible given the patient's health and safety, the hospital shall allow
at least one parent/guardian to remain with the patient at all times.
(8) The hospital shall require
that a member of the medical staff who has privileges to admit patients shall
assume the principal obligation and responsibility for managing the patient's
medical care. Postgraduate trainees and supervising physicians shall consult
with and be directed by the attending practitioner with regard to therapeutic
decisions and changes in patient status. Direct patient care may be provided by
postgraduate trainees and medical students, within their permitted scope of
responsibility and privileges with supervision as required in section
405.4 of this Part with the
concurrence of the attending practitioner. Occurrence of urgent or emergent
situations may preclude the attending or admitting practitioner from direct
participation in decisionmaking regarding patient care. In such circumstances,
the supervising physician shall concur in the decision, and the attending
practitioner shall be notified as soon as possible. Responsibility for such
decisions made in the absence of consultation with the responsible attending
practitioner resides with the involved postgraduate trainees and supervising
physicians.
(9) The hospital shall
provide for the assignment, management, and disposition of patients who are not
admitted as private patients of members of the medical staff. The hospital
shall develop and implement policies and procedures which provide for the
continuity of care of such patients and shall include a procedure by which each
patient is assigned to a member of the medical staff, who shall be the personal
practitioner to the patient and assume professional responsibility for his/her
care in the hospital and for a proper plan of care after discharge.
(10) No hospital shall be required to admit
any patient for the purpose of performing an induced termination of pregnancy,
nor shall any hospital be liable for its failure or refusal to participate in
any such act, provided that the hospital shall inform the patient of its
decision not to participate in such an act or acts. The hospital in such event
shall inform the patient of appropriate resources for services or
information.
(11) A complete and
permanent record shall be maintained of all patients admitted, including but
not limited to the date and time of admission, name and address, date of birth,
the next of kin or sponsor, veteran status (insofar as these are obtainable),
the admitting diagnosis, condition, the name of the referring practitioner, the
hospital attending practitioner or service, and as to discharge, the date and
time, condition and principal diagnosis.
(i)
If a patient is identified as a veteran, the hospital shall notify such veteran
of the possible availability of services at a hospital operated by the
Veteran's Administration. For the purposes of this paragraph, a
veteran shall be defined as a person who served in the United
States Military, who received a discharge other than a dishonorable discharge
and who is eligible for benefits provided by the Veteran's
Administration.
(ii) If a patient
eligible for transfer to a hospital operated by the Veteran's Administration
requests such transfer, hospital staff shall make such arrangements. Transfer
shall be effected in accordance with paragraph (h)(7) of this
section.
(12) Every
patient shall have a complete history and physical examination performed by an
appropriately credentialed practitioner within 30 days before or 24 hours after
admission. If recorded in the patient's medical record by an individual other
than the attending practitioner, the history and physical examination shall be
reviewed and countersigned by the attending practitioner. When the history and
physical is completed within the 30 days prior to admission, an examination, to
update any changes in the patient's health status, must be completed and
documented in the patient's medical record within 24 hours after admission.
(i) Such examination shall include a
screening uterine cytology smear on women 21 years of age and over, unless such
test is medically contraindicated or has been performed within the previous
three years, and palpation of breast, unless medically contraindicated, for all
women over 21 years of age. These examinations shall be recorded in the medical
record.
(ii) Insofar as it is
possible to identify patients who may be susceptible to sickle cell anemia, all
such presumptively susceptible patients, including infants over six months of
age, shall be examined for the presence of sickle cell hemoglobin unless such
test has been previously performed and the results recorded in the patient's
medical record or otherwise satisfactorily recorded, such as on an
identification card.
(13) No patient 18 years of age or older
shall be detained in a hospital against his will, nor shall a minor be detained
against the will of his parent or legal guardian, except as authorized by law.
This provision shall not be construed to preclude or prohibit attempts to
persuade a patient to remain in the hospital in his/her own interest, nor the
temporary detention of a mentally disturbed patient for the protection of
himself/herself or others, pending prompt legal determination of his/her
rights. In no event shall a patient be detained solely for nonpayment of
his/her hospital bill or practitioner's statement for medical
services.
(14) The hospital shall
adopt and make public the following admission notices to be provided to all
patients receiving inpatient hospital care. Medicare patients shall be given
the notice set forth in subparagraph (i) and all other inpatients shall be
given the notice set forth in subparagraph (ii) of this paragraph.
(i) Hospital Admission Notice for Medicare
Patients
You have the following rights under the New York State
law:
Before you are discharged, you must receive a written
Discharge Plan. You or your representative have the right to be involved in
your discharge planning.
Your written Discharge Plan must describe the
arrangements for any future health care that you may need after discharge. You
may not be discharged until the services required in your written Discharge
Plan are secured or determined to be reasonably available.
If you do not agree with the Discharge Plan or believe
the services are not reasonably available, you may call the New York State
Health Department to investigate your complaint and the safety of your
discharge. The hospital must provide you with the Health Department's telephone
number if you ask for it.
For important information about your rights as a Medicare
patient, see the "IMPORTANT MESSAGE FROM MEDICARE," which you must receive when
admitted to a hospital.
(ii)
Hospital Admission Notice
An Important Message Regarding Your Rights as a Hospital
Inpatient
Your Rights While a Hospital Patient
You have the right to receive all of the hospital care
that you need for the treatment of your illness or injury. Your discharge date
is determined only by YOUR health care needs, not by your DRG category or your
insurance.
You have the right to be fully informed about decisions
affecting your care and your insurance coverage. ASK QUESTIONS. You have the
right to designate a representative to act on your behalf.
You have the right to know about your medical condition.
Talk to your doctor about your condition and your health care needs. If you
have questions or concerns about hospital services, your discharge date or your
discharge plan, consult your doctor or a hospital representative (such as the
nurse, social worker, or discharge planner).
Before you are discharged you must receive a written
DISCHARGE NOTICE and a written DISCHARGE PLAN. You and/or your representative
have the right to be involved in your discharge planning.
You have the right to appeal the written
discharge plan or notice you receive from the hospital.
IF YOU THINK YOU ARE BEING ASKED TO LEAVE THE
HOSPITAL TOO SOON
Be sure you have received the written notice of discharge
that the hospital must give you. You need this discharge notice in order to
appeal.
This notice will say who to call and how to
appeal. To avoid extra charges you must call to appeal by 12 noon of
the day after you receive the notice. If you miss this time you may still
appeal. However, you may have to pay for your continued stay in the hospital,
if you lose your appeal.
DISCHARGE PLANS
In addition to the right to appeal, you have the right
to:
Receive a written discharge plan that describes the
arrangements for any future health care you may need after discharge. You may
not be discharged until the services required in your written discharge plan
are secured or determined by the hospital to be reasonably available. You also
have the right to appeal this discharge plan.
PATIENTS' RIGHTS
A general statement of your additional rights as a
patient must be provided to you at this time.
FOR ASSISTANCE/HELP
The Independent Professional Review Agent (IPRA) for your
area and your insurance coverage is:
(Hospitals are permitted to use a checklist to indicate
the IPRA that the patient should contact.)
(15) In conjunction with the requirements for
complete history and physical examination as established in this section,
hospitals approved by the Office of Alcoholism and Substance Abuse Services
(OASAS) or the Division of Alcoholism and Alcohol Abuse, a predecessor agency,
shall provide a health intervention services (HIS) program to screen all
admitted patients for signs of alcoholism or alcohol abuse that may relate to
the condition requiring hospital admission. Specifically, such hospitals shall:
(i) maintain a dedicated staff that are
adequate in number and trained, including continuing education and inservice
training, to perform all the activities required of the HIS program;
(ii) identify patients who exhibit signs of
alcoholism or alcohol abuse through a comprehensive screening protocol;
and
(iii) offer patients
intervention and referral services consistent with their assessed
needs.
(16) The hospital
shall ask each patient for the name of his or her primary care provider, if
known, on admission and shall document such information in the patient's
medical record.
(c)
Treatment of sexual offense survivors and maintenance of sexual offense
evidence.
(1) Treatment of survivors.
Hospital shall:
(i) maintain current
protocols regarding the care of patients reporting sexual assault;
(ii) provide a patients who are suspected or
confirmed victims of sexual offenses appropriate assessment, emergency
treatment and referrals to meet the health care needs of such individuals, to
provide emotional support to them and to minimize further trauma;
(iii) advise patients of the availability of
services provided by a local rape crisis or victim assistance organization and,
unless the patient declines such services, contact such organization with
information concerning the age and sex of the victim, language spoken by the
victim if other than English, and any other information that may impact the
assignment of a victim advocate, such as mental retardation, etc., so that a
representative may offer the patient the services that the organization
provides;
(iv) as provided by the
department and consistent with current standards of professional practice,
provide to patients written and verbal information necessary to make an
informed choice in regard to treatment options, including pregnancy
prophylaxis;
(v) provide to
patients, upon request, prophylaxis against pregnancy, sexually transmitted
diseases, hepatitis B and HIV, as medically indicated;
(vi) discuss with patients the option of
reporting the sexual offense to the police, and upon consent of the patient,
report the offense to the local law enforcement agency; and
(vii) reasonably assure patients an
appropriate and safe discharge.
(2) Maintenance of sexual offense evidence.
The hospital shall provide for the maintenance of
evidence of sexual offenses. The hospital shall establish and implement written
policies and procedures that are consistent with the requirements of this
section and that shall apply to all service units of the hospital which treat
victims of sexual offenses, including but not limited to medicine, surgery,
emergency, pediatric and outpatient services.
(i) The sexual offenses subject to the
provisions of this subdivision shall be sexual misconduct, rape, sodomy, sexual
abuse and aggravated sexual abuse as defined in article 130 of the Penal
Law.
(ii) The sexual offense
evidence shall include, as appropriate to the injuries sustained in each case,
slides, cotton swabs, clothing or portion thereof, hair combings, fingernail
scrapings, photographs, and other items specified by the local police agency
and forensic laboratory in each particular case.
(iii) The hospital shall preserve items of
sexual offense evidence and ensure that clothes and samples or swabs are dried,
stored in paper bags and labeled, and shall mark and log each item of evidence
with a code number corresponding to the patient's medical record
number.
(iv)
Privileged
sexual offense evidence shall mean evidence collected or obtained from
the patient during the hospital examination and treatment of injuries sustained
as a result of a sexual offense.
(v)
Sexual offense evidence that is
not privileged shall mean evidence which is obtained from victims of
suspected child abuse or maltreatment, and that derived from other alleged
crimes, attendant to or committed simultaneously with the sexual offense, which
are required to be reported to a police agency, such as bullet or gunshot
wounds, powder burns, burn injuries, which may also be required to be reported
to the state fire administrator, or other injuries arising from or caused by
the discharge of a gun or firearm, or wounds which may result in death and
which are inflicted by a knife, ice pick or other sharp or pointed instrument
in accordance with sections
265.25 and
265.26 of the
Penal Law. Nothing in this paragraph shall prevent the reporting of diseases or
medical conditions required by law to be reported to health
authorities.
(vi) Upon admission of
a patient who is an alleged sexual offense survivor, the hospital shall seek
patient consent, or consent of the person authorized to act on the patient's
behalf, for collection and storage of the sexual offense evidence and shall
explain the specific rights of the patient and obligations of the hospital as
outlined in this paragraph. The hospital shall store the sexual offense
evidence in a locked, separate and secure area for not less than 30 days
unless:
(a) the patient or person authorized
to act on the patient's behalf signs a statement directing the hospital not to
collect and keep privileged evidence; or
(b) such evidence is privileged and the
patient or person authorized to act on the patient's behalf signs a statement
directing the hospital to surrender the evidence to the police before the
30-day period has expired; or
(c)
the evidence is not privileged and the police request its surrender before
30-day period has expired.
(vii) If none of the above acts have occurred
within 30 days from commencement of treatment, the evidence shall be discarded
and the patient's possessions shall be returned upon the patient's
request.
(viii) The hospital shall
designate a staff member to coordinate the required actions and to contact the
local police agency and forensic laboratory to determine their specific needs
and requirements for the maintenance of sexual offense evidence.
(d)
Child abuse
and maltreatment. The hospital shall provide for the identification,
assessment, reporting and management of cases of suspected child abuse and
maltreatment. The hospital shall establish and implement written policies and
procedures which are consistent with the requirements of this section and which
shall apply to all service units of the hospital which treat victims of child
abuse and maltreatment, including but not limited to medicine, surgery,
emergency, pediatrics and outpatient services.
(1) The hospital shall provide orientation
and continuing education to the nursing, medical and social work personnel of,
at least, the hospital's emergency, pediatric and outpatient services in the
recognition of indicators of domestic violence and suspected child abuse and
maltreatment and in the individual's responsibilities in dealing with such
case.
(2) A staff member shall be
designated to coordinate the required reporting to the New York State Central
Register of Child Abuse and Maltreatment and the hospital's actions taken with
respect to such cases in accordance with procedures set forth in article 6,
title 6 of the State Social Services Law.
(e)
Domestic violence. The
hospital shall provide for the identification, assessment, treatment and
appropriate referral of cases of suspected or confirmed domestic violence
victims. The hospital shall establish and implement written policies and
procedures consistent with the requirements of this section which shall apply
to all service units of the hospital.
(f)
Individuals with substance use
disorders. The hospital shall develop and maintain written policies
and procedures for inpatient and outpatient care of individuals with documented
substance use disorders or who appear to have or be at risk for substance use
disorders, as that term is defined in section
1.03 of the
Mental Hygiene Law. Such policies and procedures shall, at a minimum, meet the
following requirements:
(1) policies and
procedures shall provide for the use of an evidence-based approach to identify
and assess individuals for substance use disorders, and to refer individuals
with documented substance use disorders or who appear to have or be at risk for
substance use disorders;
(2) upon
admission, treatment, or discharge of an individual with a documented substance
use disorder or who appears to have or be at risk for a substance use disorder,
including discharge or transfer from the emergency service of the hospital or
assignment to observation services pursuant to section
405.19(e)(2) of
this Part, the hospital shall inform the individual of the availability of the
substance use disorder treatment services that may be available to him or her
through a substance use disorder services program. Such information may be
provided verbally and/or in writing as appropriate;
(3) during discharge planning, the hospital
shall provide to each individual with a documented substance use disorder or
who appears to have or be at risk for a substance use disorder with educational
materials, identified by the office of Alcoholism and Substance Abuse Services
in consultation with the department and provided to the hospital pursuant to
section
2803-u
(1) of the Public Health Law;
(4) except where an individual has come into
the hospital under section
22.09 of
the Mental Hygiene Law, and where the hospital does not directly provide
substance use disorder services, the hospital shall refer individuals in need
of substance use disorder services to and coordinate with appropriate substance
use disorder services programs that provide behavioral health services, as
defined in section
1.03 of the
Mental Hygiene Law; and
(5) the
hospital shall establish and implement training, in addition to current
training programs, for all individuals licensed or certified pursuant to Title
8 of the Education Law who provide direct patient care regarding the policies
and procedures established in this paragraph.
(g)
Human trafficking.
The hospital shall provide for the identification,
assessment, and appropriate treatment or referral of individuals who are
suspected to be human trafficking victims, as that term is defined in section
483-aa
of the Social Services Law and used in article 10-D of the Social Services Law.
The hospital shall establish and implement written policies and procedures,
which shall apply to all service unites of the hospital and, at a minimum,
shall meet the following requirements:
(1) policies and procedures shall provide for
the identification, assessment, and appropriate treatment or referral of
individuals who are suspected to be human trafficking victims;
(2) in the case of individuals who are
suspected to be human trafficking victims and are under 18 years old, policies
and procedures shall provide for the reporting of such persons as an abused or
maltreated child if required under title 6 of article 6 of the Social Services
Law;
(3) the hospital shall inform
individuals who are suspected to be human trafficking victims of services that
may be available, including those referenced in article 10-D of the Social
Services Law. Referrals also may be made to other health care providers,
appropriate state agencies, and/or other providers of services as appropriate.
Such information may be provided verbally and/or in writing as
appropriate;
(4) the hospital shall
post the human trafficking hotline poster issued by the National Human
Trafficking Resources Center, or a variation of such poster created by the
Office of Temporary and Disability Assistance (OTDA) consistent with section
483-ff
of the Social Services Law, whichever OTDA makes available on its website.
Posters shall be placed in conspicuous locations near primary public entrances
and where other posters and notices are posted; and
(5) the hospital shall establish and
implement training, which may be incorporated into current training programs,
for all individuals licensed or certified pursuant to title 8 of the Education
Law who provide direct patient care, and for all security personnel, regarding
the policies and procedures established pursuant to this subdivision. Such
training shall include training in the recognition of indicators of a human
trafficking victim and the responsibilities of such personnel in dealing with
persons suspected as human trafficking victims.
(h)
Discharge.
(1) The hospital shall ensure that each
patient has a discharge plan which meets the patient's post-hospital care
needs. No patient who requires continuing health care services in accordance
with such patient discharge plan may be discharged until such services are
secured or determined by the hospital to be reasonably available to the
patient.
(2) The hospital shall
have a discharge planning coordinator responsible for the coordination of the
hospital discharge planning program. The discharge planning coordinator shall
be an individual with appropriate training and experience as determined by the
hospital to coordinate the hospital discharge planning program.
(3) The hospital shall ensure:
(i) that discharge planning staff have
available current information regarding home care programs, institutional
health care providers, and other support services within the hospital's primary
service area, including their range of services, admission and discharge
policies and payment criteria;
(ii)
the utilization of written criteria as part of a screening system for the early
identification of those patients who may require post-hospital care planning
and services. Such criteria shall reflect the hospital's experience with
patients requiring post-hospital care and shall be reviewed and updated
annually;
(iii) that upon the
admission of each patient, information is obtained as required to assist in
identifying those patients who may require post-hospital care
planning;
(iv) that each patient is
screened as soon as possible following admission in accordance with the written
criteria described in subparagraph (ii) of this paragraph and that this
screening is coordinated with the utilization review process;
(v) that each patient identified through the
screening system as potentially in need of post-hospital care is assessed by
those health professionals whose services are appropriate to the needs of the
patient to determine the patient's post-hospital care needs. Such assessment
shall include an evaluation of the extent to which the patient or patient's
personal support system can provide or arrange to provide for identified care
needs while the patient continues to reside in his/her personal
residence;
(vi) that for each
patient determined to need assistance with post-hospital care, the health
professionals whose services are medically necessary, together with the patient
and the patient's family/representative shall develop an individualized
comprehensive discharge plan consistent with medical discharge orders and
identified patient needs;
(vii)
that each patient determined to need assistance with post-hospital care and the
patient's family/representative receive verbal and written information
regarding the range of services in the patient's community which have the
capability of assisting the patient and the patient's family/representative in
implementing the patient' s individualized discharge plan which is appropriate
to the patient's level of care needs;
(viii) that the patient and the patient's
family/representative shall have the opportunity to participate in decisions
regarding the selection of post-hospital care consistent with and subject to
any limitations of Federal and State laws. Planning for post-hospital care
shall not be limited to placement in residential health care facilities for
persons assessed to need that level of care, but shall include consideration of
noninpatient services such as home care, long-term home health care, hospice,
day care and respite care;
(ix)
that when residential health care facility placement is indicated, the patient
and the patient's family/representative shall be afforded the opportunity,
consistent with and subject to any limitations of Federal and State laws, to
participate in the selection of the residential health care facilities to which
applications for admission are made.
(x) that contact with appropriate providers
of health care and services is made as soon as possible, but no later than the
day of assignment of alternate level of care status and that each patient's
record contains a record of all such contacts including date of contact and
provider response as well as a copy of any standard assessment form, including
but not limited to any hospital/community patient review instrument as
contained in section
400.13 of this Title and any home
health assessment, completed by the hospital for purposes of post-hospital
care;
(xi) that relevant discharge
planning information is available for the utilization review committee;
and
(xii) the development and
implementation of written criteria for use in the hospital emergency service
indicating the circumstances in which discharge planning services shall be
provided for a person who is in need of post emergency care and services but
not in need of inpatient hospital care.
(4) The hospital shall establish and
implement written policies and procedures governing the admissions and
discharge process which ensure compliance with State and Federal
antidiscrimination laws which apply to the operator. Such laws include, but
need not be limited to, the applicable provisions of this Part; Public Health
Law, section 2801-a(9); the New York State Civil Rights Law, sections 40 and
40-c; article 15 (Human Rights Law) of the State Executive Law, sections 291,
292 and 296; and title 42 of the United States Code, sections 1981, 2000a,
2000a-2, 2000d, 3602, 3604 and 3607. Copies of the cited State and Federal
statutes are available from West Publishing Company, P.O. Box 64526, St. Paul,
MN 55164-0526, the publisher of McKinney's Consolidated Laws of New
York annotated and the United States Code annotated. Copies of such
statutes are also available for public inspection and copying at the Records
Access Office, New York State Department of Health, Corning Tower Building,
Governor Nelson A. Rockefeller Empire State Plaza, Albany, NY 12237.
(5) Discharge planners shall inform each
patient and his/her family of the admission policies of the residential health
care facilities to which they are referred.
(6) The requirements of this subdivision
relating to a patient's family/representative participating in the discharge
planning process and in receiving an explanation of the reason for a patient's
transfer or discharge shall not apply in the following circumstances:
(i) when a competent adult patient objects to
such participation by, or to an explanation regarding transfer or discharge
being given to, any family/representative. Any such objections shall be noted
in the patient's medical record; or
(ii) when the hospital has made a reasonable
effort to contact a patient's family/representative in order to provide an
opportunity to participate in the discharge planning process or to explain the
reason for transfer or discharge, and the hospital is unable to locate a
responsible family member/representative, or, if located, such individual
refuses to participate. The reasons a patient's family/representative did not
participate in the discharge planning process or did not receive an explanation
of the reason for a patient's transfer or discharge shall be noted in the
patient's medical record. A reasonable effort shall include, but not be limited
to, attempts to contact a patient's family/representative by telephone,
telegram and/or mail.
(7) The hospital shall ensure that no person
presented for medical care shall be removed, transferred or discharged from a
hospital based upon source of payment. Each removal, transfer or discharge
shall be carried out after a written order made by a physician that, in his/her
judgment, such removal, transfer or discharge will not create a medical hazard
to the person or that such removal, transfer or discharge is considered to be
in the person's best interest despite the potential hazard of movement. Such a
removal, transfer or discharge shall be made only after explaining the need for
removal, transfer or discharge to the patient and to the patient's
family/representative and prior notification to the medical facility expected
to receive the patient.
(i) The hospital
shall maintain a record of all removals, discharges and transfers from the
hospital, including the date and time of the hospital reception or admission,
name, sex, age, address, presumptive diagnosis, treatment provided, clinical
condition, reason for removal, transfer or discharge and destination. A copy of
such information shall accompany any person transferred or discharged to a
health care facility or a certified or licensed home care services agency and,
where applicable become a part of the person's medical record.
(ii) Patients discharged from the hospital by
their attending practitioner shall not be permitted to remain in the hospital
without the consent of the chief executive officer of the hospital except in
accordance with provisions of subdivision (i) of this section.
(iii) In the absence of a written order of an
attending practitioner discharging a patient, with respect to a patient who
insists upon discharging himself from the hospital, the hospital shall obtain,
where practicable, a written release from the patient absolving the hospital
and the patient's attending practitioner of liability and damages resulting
from such discharge.
(8)
Unless otherwise provided by law, the hospital shall ensure that a minor shall
be discharged only in the custody of his parent, a member of his immediate
family or his legal guardian or custodian, unless such parent or guardian shall
otherwise direct.
(9) A dead body,
including a stillborn infant or fetus estimated by an attending physician to
have completed 20 weeks of gestation, shall be delivered only to a licensed
funeral director or undertaker or his/her agent. If, at the time of death, the
patient was diagnosed as having a specific communicable or infectious disease,
including but not limited to those diseases designated in Part 2 of this Title,
a written report of such disease shall accompany the body when it is released
to the funeral director or his/her agent.
(10) The hospital shall develop and implement
written policies and procedures pertaining to the review and communication of
laboratory and diagnostic test/service results ordered for a patient while
admitted or receiving emergency services to the patient. If the patient lacks
medical decision-making capacity, the communication shall be to the patient's
medical decision-maker. The results shall also be provided to the patient's
primary care provider, if known. Such policies and procedures shall be reviewed
and updated as necessary and at a minimum shall include:
(i) a requirement that all laboratory and
other diagnostic tests/service results be reviewed upon completion by a
physician, physician assistant or nurse practitioner familiar with the
patient's presenting condition;
(ii) a requirement that all laboratory and
other diagnostic test services results be forwarded to the patient's primary
provider, if known, after review by a physician, physician assistant or nurse
practitioner;
(iii) provisions to
include in the discharge plan information regarding the patient's completed and
pending laboratory and other diagnostic test/service results, medications,
diagnoses, and follow-up care and to review such information with the patient
or, if the patient is not legally capable of making decisions, the patient's
parent, legal guardian or health care agent, or surrogate, as appropriate,
subject to all applicable confidentiality laws and regulations;
(iv) a requirement that patients may not be
discharged from the hospital or the emergency room until any tests that could
reasonably be expected to yield "critical value" results - results that suggest
a life-threatening or otherwise significant condition such that it requires
immediate medical attention - are reviewed by a physician, physician assistant
(PA) and/or nurse practitioner (NP);
(v) a requirement that before a patient is
discharged, any critical laboratory test results are communicated to the
patient or, if the patient is not legally capable of making decisions, the
patient's parent, legal guardian or health care agent, or surrogate, as
appropriate, subject to all applicable confidentiality laws and
regulations;
(vi) a requirement
that all information be presented to the patient or if the patient is not
legally capable of making decisions, the patient's parent, legal guardian or
health care agent, or surrogate, as appropriate, subject to all applicable
confidentiality laws and regulations, in a manner that reasonably assures that
the patient, their parents or other medical decision makers understand the
health information provided in order to make appropriate health
decisions.
(i)
Hospital inpatient discharge review
program.
(1) A hospital inpatient
discharge review program applicable to all patients other than beneficiaries of
title XVIII of the Federal Social Security Act (Medicare) shall be established
in accordance with this subdivision. No hospital inpatient subject to the
provisions of this subdivision may be discharged on the basis that inpatient
hospital service in a general hospital is no longer medically necessary and
that an appropriate discharge plan has been established unless a written notice
of such determinations and a copy of the discharge plan have been provided to
the patient or the appointed personal representative of the patient. The
patient or the appointed personal representative of the patient shall have the
opportunity to sign the notice and a copy of the discharge plan and receive a
copy of both signed documents. Every hospital shall use the common notice set
forth in paragraph (9) of this subdivision. The patient, or the appointed
personal representative of the patient may request a review of such
determinations by the appropriate independent professional review agent or
review agent in accordance with paragraph (4) of this subdivision.
Notwithstanding that the patient discharge review process provided in
accordance with Federal law and regulation shall apply to beneficiaries of
title XVIII of the Federal Social Security Act (Medicare), a written copy of
the discharge plan, and discharge notice shall be provided to the beneficiary
or the appointed personal representative of the beneficiary. The beneficiary or
the appointed personal representative of the beneficiary shall have the
opportunity to sign the documents and receive a copy of the signed
documents.
(2)
(i) For patients eligible for payments by
state governmental agencies for hospital inpatient services as the patient's
primary payor an independent professional review agent shall
mean the commissioner or his designee. In conducting hospital inpatient
discharge reviews in accordance with this paragraph, the commissioner may
utilize the services of department personnel or other authorized
representatives, including a review agent approved in accordance with
subparagraph (ii) of this paragraph.
(ii) For patients who are not beneficiaries
of title XVIII of the Federal Social Security Act (Medicare) nor eligible for
payments by state governmental agencies as the patient's primary payor, an
independent professional review agent shall mean a third-party
payor of hospital services or other corporation approved by the commissioner in
writing for purposes of conducting hospital inpatient discharge reviews in
accordance with this subdivision. For a third-party payor of hospital services
or other corporation to be approved as an independent professional review agent
in accordance with this subparagraph, such third-party payor or other
corporation must meet the following approval criteria:
(a) the review agent shall employ or
otherwise secure the services of adequate medical personnel qualified to
determine the necessity of continued inpatient hospital services and the
appropriateness of hospital discharge plans;
(b) the review agent shall demonstrate the
ability to render review decisions in a timely manner as provided in this
subdivision;
(c) the review agent
shall agree to provide ready access by the commissioner to all data, records
and information it collects and maintains concerning its review activities
under this subdivision;
(d) the
review agent shall agree to provide to the commissioner such data, information
and reports as the commissioner determines necessary to evaluate the review
process provided pursuant to this subdivision;
(e) the review agent shall provide assurances
that review personnel shall not have a conflict of interest in conducting a
discharge review for a patient based on hospital or professional affiliation;
and
(f) the review agent meets such
other performance and efficiency criteria regarding the conduct of reviews
pursuant to this subdivision established by the commissioner
The commissioner may withdraw approval of an independent
professional review agent where such review agent fails to continue to meet
approval criteria established pursuant to this subparagraph.
(iii) Each hospital shall enter
into contracts with one or more independent professional review agents approved
by the commissioner in accordance with subparagraph (ii) of this paragraph for
purposes of conducting hospital inpatient discharge reviews in accordance with
this subdivision for patients, including uncompensated care patients, who are
not beneficiaries of title XVIII of the Federal Social Security Act (Medicare)
nor eligible for payments by State governmental agencies as the patient's
primary payor; provided, however, a payor of hospital service authorized under
article 43 of the State Insurance Law or certified as health maintenance
organizations under article 44 of the Public Health Law, may designate the
review agent for their subscribers or beneficiaries or enrolled members and
shall reimburse such designated review agent for costs of the discharge review
program.
(3)
(i) If a hospital and the attending physician
agree that inpatient hospital service in a hospital is no longer medically
necessary for a patient, other than a beneficiary of title XVIII of the Federal
Social Security Act (Medicare), and an appropriate discharge plan has been
established for such patient, at that time the hospital shall provide the
patient or the appointed personal representative of the patient with a written
discharge notice and a copy of the discharge plan, meeting the requirements of
paragraph (1) of this subdivision.
(ii) If a hospital has determined that
inpatient hospital service in a hospital is no longer medically necessary for a
patient, other than a beneficiary of title XVIII of the Federal Social Security
Act (Medicare), and an appropriate discharge plan has been established for such
patient but the attending physician has not agreed with the hospital's
determinations, the hospital may request by telephone a review of the validity
of the hospital's determinations by the appropriate independent professional
review agent. Such review agent shall conduct a review of the hospital's
determinations and prior to the conclusion of the review shall provide an
opportunity to the treating physician and an appropriate representative of the
hospital to confer and provide information which may include the patient's
clinical records if requested by the review agent. Such review agent shall
notify the hospital of the results of its review not later than one working day
after the date the review agent has received the request, the records required
to conduct such review, and the date of such conferring and receipt of any
additional information requested. The hospital shall provide notice to the
attending physician of the results of the review. If the review agent concurs
with the hospital's determinations, the hospital shall provide the patient or
his appointed personal representative with a written notice of such
determinations and notice that the patient shall be financially responsible for
continued stay, and with a copy of the proposed discharge plan. The patient or
the appointed personal representative of the patient shall have the opportunity
to sign the notice and a copy of the proposed discharge plan and receive a copy
of both signed documents. Every hospital shall use the notice set forth in
paragraph (l0) of this subdivision which shall indicate the determinations
made, shall state the reasons therefor and that the patient's attending
physician has disagreed, and shall state that the patient or the appointed
personal representative of the patient may request a review of such
determinations by the appropriate review agent.
(4) A patient in a hospital, or the appointed
personal representative of the patient, who receives a written notice in
accordance with subparagraph (3)(i) or (3)(ii) of this subdivision, may request
a review by the appropriate review agent of the determinations set forth in
such notice related to medical necessity of continued inpatient hospital
service, the appropriateness of the discharge plan and the availability of
required continuing health care services.
(i)
If a patient while still hospitalized or while no longer an inpatient, or the
appointed personal representative of such patient, requests a review by the
appropriate review agent, the hospital shall promptly provide to the review
agent the records required to review the determinations. Such request for a
patient no longer an inpatient shall take place no later than 30 days after
receipt of a notice provided in accordance with paragraph (3) of this
subdivision or seven days after receipt of a complete bill for all inpatient
services rendered, whichever is later. The review agent shall conduct a review
of such determinations, and shall provide the treating physician and an
appropriate representative of the hospital with an opportunity to confer and
provide information prior to the conclusion of the review. The review agent
shall provide written notice to the patient, or the appointed personal
representative of the patient, and the hospital of the results of the review
within three working days of receipt of the requests for review and the records
required to review the determinations. The hospital shall provide notice to the
attending physician of the results of the review.
(ii) If a patient while still an inpatient in
the hospital, or the appointed personal representative of the patient, requests
a review by the appropriate review agent not later than noon of the first
working day after the date the patient, or the appointed personal
representative of the patient, receives the written notice, the hospital shall
provide to the appropriate review agent the records required to review the
determinations by the close of business of such working day. The appropriate
review agent shall conduct a review of such determinations and provide written
notice to the patient, or the appointed personal representative of the patient,
and the hospital of the results of the review not later than one full working
day after the date the review agent has received the request for review and
such records. The hospital shall provide notice to the attending physician of
the results of the review.
(5) If the appropriate review agent, upon any
review conducted pursuant to subparagraph (3)(ii) or pursuant to paragraph (4)
of this subdivision does not concur in the determinations, continued stay in a
hospital shall be deemed necessary and appropriate for the patient for purposes
of payment for such continued stay.
(6) If a patient eligible for payment for
inpatient hospital services under the casebased payment per discharge system or
the appointed personal representative of the patient, requests a review by the
appropriate review agent in accordance with subparagraph (4)(ii) of this
subdivision, the hospital may not demand or request any payment for additional
inpatient hospital services provided to such patient subsequent to the proposed
time of discharge and prior to noon of the day after the date the patient or
the appointed personal representative of the patient receives notice of the
results of the review by the review agent except deductibles, copayments, or
other charges that would be authorized for a patient for whom inpatient
hospital services in a hospital continue to be necessary and
appropriate.
(7) In any review
conducted pursuant to subparagraph (3)(ii) or pursuant to paragraph (4) of this
subdivision, the review agent shall solicit the views of the patient involved,
or the appointed personal representative of the patient, and the attending
physician.
(8) Each patient, or the
appointed personal representative of the patient, provided a notice by a
hospital in accordance with paragraph (3) of this subdivision shall be provided
at such time by the hospital with a notice of such patient's right to request a
discharge review in accordance with this subdivision. The patient or the
appointed personal representative of the patient shall have the opportunity to
sign this form and receive a copy of the signed form.
(9) Notice that inpatient hospital service is
no longer medically necessary. For purposes of subparagraph (3)(i) of this
subdivision, the hospital shall utilize the following notices:
(i) The following form shall be used for
patients covered under the case payment system:
DISCHARGE NOTICE
DATE:/___/___
READ THIS LETTER CAREFULLY-IT CONCERNS YOUR PRIVATE
INSURANCE
BENEFITS OR MEDICAID BENEFITS OR IF YOU ARE
UNINSURED
PATIENT NAME: __________ PRIMARY PAYOR
____________________________________________
AT DISCHARGE:
____________________________________________
ATT. PHYS. : ______ MR NO.:
____________________________________________
ADM DATE: ___ / ___ / ___
____________________________________________
Dear Patient:
Your doctor and the hospital have determined that you no
longer require care in the hospital and will be ready for discharge on:
Day of Week __ / Date / __
____________________________________________
IF YOU AGREE with this decision, you will be discharged.
Be sure you have already received your written discharge plan which describes
the arrangements for any future health care you may need.
IF YOU DO NOT AGREE and think you are not medically ready
for discharge or feel that your discharge plan will not meet your health care
needs, you or your representative may request a review. Contact the review
agent indicated on the reverse side of this letter if you would like a review
of the discharge decision.
IF YOU WOULD LIKE A REVIEW, you should immediately, but
not later than noon of
____________________________________________
(Day and Date)
call the telephone number checked off on the reverse side
of this page.
IF YOU CANNOT REQUEST THE REVIEW YOURSELF, and you do not
have a family member or friend to help you, you may ask the hospital
representative at extension, who will request the review for you.
____________________________________________
IF YOU REQUEST A REVIEW, the following will
happen:
1. The review agent will ask
you or your representative why you or your representative think you need to
stay in the hospital and also will ask your name, admission date and telephone
number where you or your representative can be reached.
2. After speaking with you or your
representative and your doctor and after reviewing your medical record, the
review agent will make a decision which will be given to you in
writing.
3. While this review is
being conducted, you will not have to pay for any additional hospital days
until you have received the review agent's decision.
IF THE REVIEW AGENT AGREES WITH THE DISCHARGE DECISION,
you will be financially responsible for your continued stay after noon of the
day after you or your representative has been notified of the review agent's
decision.
IF THE REVIEW AGENT AGREES THAT YOU STILL NEED TO BE IN
THE HOSPITAL: for Medicaid patients, Medicaid benefits will continue to cover
your stay; for private health insurance patients, coverage for your continued
stay is limited to the scope of your private health insurance policy.
NOTE: If you miss the noon deadline
mentioned on the first page of this notice, you may still request a review.
However, if the review agent disagrees with you, you will be financially
responsible for the days of care beginning with the proposed discharge
date.
If you would like a review of your hospital stay after
you have been discharged, you may request a review by the review agent within
30 days of the receipt of this notice or seven days after receipt of a complete
bill from the hospital, whichever is later, by writing to the review
agent.
I have received this notice on behalf of myself as the
patient or as the representative of the patient:
Signature __ / Date / __ Time
____________________________________________ Relationship
(ii) The following form
shall be used for patients covered under a per diem reimbursement system:
DISCHARGE NOTICE
DATE /__/__
READ THIS LETTER CAREFULLY-IT CONCERNS YOUR PRIVATE
INSURANCE
BENEFITS OR MEDICAID BENEFITS OR IF YOU ARE
UNINSURED
PATIENT NAME: __________ PRIMARY PAYOR
____________________________________________
AT DISCHARGE:
____________________________________________
ATT. PHYS. : ______ MR NO.:
____________________________________________
ADM DATE: ___ / ___ / ___
____________________________________________
Dear Patient:
Your doctor and the hospital have determined that you no
longer require care in the hospital and will be ready for discharge on:
Day of Week __ / Date / __
____________________________________________
IF YOU AGREE with this decision, you will be discharged.
Be sure you have already received your written discharge plan which describes
the arrangements for any health care you may need when you leave the
hospital.
IF YOU DO NOT AGREE and think you are not medically ready
for discharge or feel that your discharge plan will not meet your health care
needs, you or your representative may request a review of the discharge
decision by contacting your review agent indicated on the reverse side of this
page.
IMPORTANT NOTICE ABOUT THE PAYMENT FOR YOUR CARE
* If your hospital care is covered by private health
insurance, you may be charged directly while you remain in the hospital while
the discharge review is being conducted. Whether you have to pay during this
period will depend on your private health insurance benefits and if the review
agent agrees with you that you need to stay in the hospital.
* If your hospital care is covered under the Medicaid
program, Medicaid will pay for the days you remain in the hospital while the
discharge review is being conducted.
IF YOU WOULD LIKE A REVIEW, you should immediately, but
not later than noon of
____________________________________________
(Day and Date)
call the telephone number checked off on the reverse side
of this page.
IF YOU CANNOT REQUEST THE REVIEW YOURSELF, and you do not
have a family member or friend to help you, you may ask the hospital
representative at extension, who will request the review for you.
____________________________________________
IF YOU REQUEST A REVIEW, the following will
happen:
1. The review agent will ask
you or your representative why you or your representative think you need to
stay in the hospital and also will ask your name, admission date and telephone
number where you or your representative can be reached.
2. After speaking with you or your
representative and your doctor and after reviewing your medical record, the
review agent will make a decision which will be given to you in writing.
IF THE REVIEW AGENT AGREES WITH THE DISCHARGE DECISION,
you will be financially responsible for your continued stay after noon of the
day you or your representative has been notified of the review agent's
decision.
IF THE REVIEW AGENT AGREES THAT YOU STILL NEED TO BE IN
THE HOSPITAL: for Medicaid patients, Medicaid benefits will continue to cover
your stay; for private health insurance patients, coverage for your continued
stay is limited to the scope of your private health insurance policy.
NOTE: If you miss the noon deadline
mentioned on the first page of this notice, you may still request a review.
However, if the review agent disagrees with you, you will be financially
responsible for the days of care beginning with the proposed discharge
date.
If you would like a review of your hospital stay after
you have been discharged, you may request a review by the review agent within
30 days of the receipt of this notice or seven days after receipt of a complete
bill from the hospital, whichever is later, by writing to the review
agent.
I have received this notice on behalf of myself as the
patient or as the representative of the patient:
Signature __ / Date / __ Time
____________________________________________ Relationship
(10) Notice
that inpatient hospital services is no longer medically necessary. For purposes
of subparagraph (3)(ii) of this subdivision, a hospital shall utilize the
following notice:
HOSPITAL LETTERHEAD
DATE /__/__
CONTINUED STAY DISCHARGE NOTICE
(ATTENDING PHYSICIAN AGREES/REVIEW AGENT AGREES)
READ THIS LETTER CAREFULLY-IT CONCERNS YOUR
INSURANCE
BENEFITS OR MEDICAID BENEFITS
PATIENT NAME:
____________________________________________
PRIMARY PAYOR:
____________________________________________
ADDRESS:
____________________________________________
ATT.
PHYS. :
____________________________________________
MR NO.:
ADM. DATE: __/__/__
Dear Patient:
After careful review of your medical record and
consideration of your own views regarding medical condition, the (name of
review agent) (the review agent approved by the Department of Health) has
agreed with the hospital that you no longer require care in the hospital
because you are ready for discharge.
IF YOU AGREE with this decision, you should discuss with
your doctor the arrangements for any further health care you may need. This
means if you have health insurance benefits or Medicaid benefits, these
benefits will no longer pay for any additional hospital days as of:
Day of Week __ / Date / __
____________________________________________
____________________________________________
IF YOU DO NOT AGREE THAT YOU ARE READY FOR DISCHARGE,
IMMEDIATELY AFTER RECEIPT OF THIS NOTICE YOU OR YOUR REPRESENTATIVE MAY CALL
THE (name of review agent) AT (phone no.) TO REQUEST AN IMMEDIATE REREVIEW OF
YOUR MEDICAL RECORD.
____________________________________________
If you cannot request the reconsideration yourself and
you do not have a representative to help you, you may notify the hospital
representative at extension __ to request the reconsideration to you. In either
case, the individual review agent approved by the Department of Health will
request your name, admission date, and telephone number where you or your
representative can be reached. If the individual review agent approved by the
Department of Health did not ask your views before, it must do so now.
IF YOU REQUEST A REVIEW, the following will
happen:
(1) You or your representative
will be informed in writing of the results of the review.
(2) IF THE REVIEW AGENT AGREES WITH THE
HOSPITAL's DECISION that you are ready for discharge or that your condition
could be safely treated in another setting and you have health insurance
benefits or Medicaid benefits, your health insurance benefits or Medicaid
benefits will PAY FOR YOUR STAY ONLY UNTIL NOON OF THE NEXT DAY AFTER YOU OR
YOUR REPRESENTATIVE HAVE BEEN NOTIFIED.
(3) If the review agent determines that you
still need to be in the hospital, for purposes of payments under health
insurance or Medicaid benefits, your continued stay will be considered
necessary and appropriate.
IN EITHER CASE (2 OR 3), YOU WILL NOT HAVE TO PAY FOR ANY
ADDITIONAL HOSPITAL DAYS UNTIL YOU HAVE BEEN NOTIFIED OF THE REVIEW AGENT
DETERMINATION.
NOTE: If you miss the noon deadline
mentioned on the reverse side of this notice, you may still request a review
during your hospital stay. However, if the review agent rules against you, you
will be financially responsible starting on the date you receive the notice. Of
course, if the review agent determination is in your favor, you are not liable
for payment for the extra days.
If you would like a review of your hospital stay after
you have been discharged, you may request an individual review agent review
within 30 days of receipt of this notice or seven days after receipt of a
complete bill from the hospital, whichever is later, by writing to the review
agent.
(REVIEW AGENT NAME/ADDRESS)
____________________________________________
____________________________________________
(Hospital Representative Signature) _ (Date) _ (Time)
____________________________________________
If your hospital stay is not covered under the per case
payment system, you may still request a discharge review. However, you will
continue to be charged for hospital services during the review process.
IF YOU HAVE ANY DIFFICULTY UNDERSTANDING THIS NOTICE OR
IF YOU NEED MORE INFORMATION, YOU MAY CALL THE REVIEW AGENT DIRECTLY
AT: (Telephone No.)
I have received this notice on behalf of myself as the
patient or as a representative of the patient to whom it is addressed:
Signature __ / Date / __ Time
____________________________________________ Relationship
cc: Attending Physician_ Hospital Billing Office
____________________________________________
(11) The provisions of this subdivision shall
apply to hospital inpatients admitted on and after January 1,
1988.
