HOUSE BILL No. 5660 April 18, 2000, Introduced by Rep. Richner and referred to the Committee on Health Policy. A bill to amend 1978 PA 368, entitled "Public health code," by amending sections 16221, 16226, 20165, 20201, 21515, and 22210 (MCL 333.16221, 333.16226, 333.20165, 333.20201, 333.21515, and 333.22210), sections 16221 and 16226 as amended by 2000 PA 29, section 20165 as amended by 1998 PA 108, section 20201 as amended by 1998 PA 88, and section 22210 as amended by 1993 PA 88, and by adding sections 16279 and 20195. THE PEOPLE OF THE STATE OF MICHIGAN ENACT: 1 Sec. 16221. The department may investigate activities 2 related to the practice of a health profession by a licensee, a 3 registrant, or an applicant for licensure or registration. The 4 department may hold hearings, administer oaths, and order 5 relevant testimony to be taken and shall report its findings to 6 the appropriate disciplinary subcommittee. The disciplinary 04848'99 CPD 2 1 subcommittee shall proceed under section 16226 if it finds that 1 2 or more of the following grounds exist: 3 (a) A violation of general duty, consisting of negligence or 4 failure to exercise due care, including negligent delegation to 5 or supervision of employees or other individuals, whether or not 6 injury results, or any conduct, practice, or condition which 7 impairs, or may impair, the ability to safely and skillfully 8 practice the health profession. 9 (b) Personal disqualifications, consisting of 1 or more of 10 the following: 11 (i) Incompetence. 12 (ii) Subject to sections 16165 to 16170a, substance abuse as 13 defined in section 6107. 14 (iii) Mental or physical inability reasonably related to and 15 adversely affecting the licensee's ability to practice in a safe 16 and competent manner. 17 (iv) Declaration of mental incompetence by a court of compe- 18 tent jurisdiction. 19 (v) Conviction of a misdemeanor punishable by imprisonment 20 for a maximum term of 2 years; a misdemeanor involving the ille- 21 gal delivery, possession, or use of a controlled substance; or a 22 felony. A certified copy of the court record is conclusive evi- 23 dence of the conviction. 24 (vi) Lack of good moral character. 25 (vii) Conviction of a criminal offense under sections 520a 26 to 520l of the Michigan penal code, 1931 PA 328, MCL 750.520a to 04848'99 3 1 750.520l. A certified copy of the court record is conclusive 2 evidence of the conviction. 3 (viii) Conviction of a violation of section 492a of the 4 Michigan penal code, 1931 PA 328, MCL 750.492a. A certified copy 5 of the court record is conclusive evidence of the conviction. 6 (ix) Conviction of a misdemeanor or felony involving fraud 7 in obtaining or attempting to obtain fees related to the practice 8 of a health profession. A certified copy of the court record is 9 conclusive evidence of the conviction. 10 (x) Final adverse administrative action by a licensure, reg- 11 istration, disciplinary, or certification board involving the 12 holder of, or an applicant for, a license or registration regu- 13 lated by another state or a territory of the United States, by 14 the United States military, by the federal government, or by 15 another country. A certified copy of the record of the board is 16 conclusive evidence of the final action. 17 (xi) Conviction of a misdemeanor that is reasonably related 18 to or that adversely affects the licensee's ability to practice 19 in a safe and competent manner. A certified copy of the court 20 record is conclusive evidence of the conviction. 21 (c) Prohibited acts, consisting of 1 or more of the 22 following: 23 (i) Fraud or deceit in obtaining or renewing a license or 24 registration. 25 (ii) Permitting the license or registration to be used by an 26 unauthorized person. 04848'99 4 1 (iii) Practice outside the scope of a license. 2 (iv) Obtaining, possessing, or attempting to obtain or 3 possess a controlled substance as defined in section 7104 or a 4 drug as defined in section 7105 without lawful authority; or 5 selling, prescribing, giving away, or administering drugs for 6 other than lawful diagnostic or therapeutic purposes. 7 (d) Unethical business practices, consisting of 1 or more of 8 the following: 9 (i) False or misleading advertising. 10 (ii) Dividing fees for referral of patients or accepting 11 kickbacks on medical or surgical services, appliances, or medica- 12 tions purchased by or in behalf of patients. 13 (iii) Fraud or deceit in obtaining or attempting to obtain 14 third party reimbursement. 15 (e) Unprofessional conduct, consisting of 1 or more of the 16 following: 17 (i) Misrepresentation to a consumer or patient or in obtain- 18 ing or attempting to obtain third party reimbursement in the 19 course of professional practice. 20 (ii) Betrayal of a professional confidence. 21 (iii) Promotion for personal gain of an unnecessary drug, 22 device, treatment, procedure, or service. 23 (iv) Directing or requiring an individual to purchase or 24 secure a drug, device, treatment, procedure, or service from 25 another person, place, facility, or business in which the 26 licensee has a financial interest. 04848'99 5 1 (f) Failure to report a change of name or mailing address 2 within 30 days after the change occurs. 3 (g) A violation, or aiding or abetting in a violation, of 4 this article or of a rule promulgated under this article. 5 (h) Failure to comply with a subpoena issued pursuant to 6 this part, failure to respond to a complaint issued under this 7 article or article 7, failure to appear at a compliance confer- 8 ence or an administrative hearing, or failure to report under 9 section 16222 or 16223. 10 (i) Failure to pay an installment of an assessment levied 11 pursuant to the insurance code of 1956, 1956 PA 218, MCL 500.100 12 to 500.8302, within 60 days after notice by the appropriate 13 board. 14 (j) A violation of section 17013 or 17513. 15 (k) Failure to meet 1 or more of the requirements for licen- 16 sure or registration under section 16174. 17 (l) A violation of section 17015 or 17515. 18 (m) A violation of section 17016 or 17516. 19 (n) Failure to comply with section 9206(3). 20 (o) A violation of section 5654 or 5655. 21 (p) A violation of section 16274. 22 (q) A violation of section 17020 or 17520. 23 (R) A VIOLATION OF SECTION 16279. THIS SUBDIVISION ALSO 24 APPLIES TO A LICENSEE OR REGISTRANT IF A PERSON AUTHORIZED BY THE 25 LICENSEE OR REGISTRANT TO RETRIEVE OR COPY, OR BOTH, MEDICAL 26 RECORDS UNDER SECTION 16279 VIOLATES SECTION 16279. 04848'99 6 1 Sec. 16226. (1) After finding the existence of 1 or more of 2 the grounds for disciplinary subcommittee action listed in 3 section 16221, a disciplinary subcommittee shall impose 1 or more 4 of the following sanctions for each violation: 5 6 Violations of Section 16221 Sanctions 7 Subdivision (a), (b)(ii), Probation, limitation, denial, 8 (b)(iv), (b)(vi), or suspension, revocation, 9 (b)(vii) restitution, community service, 10 or fine. 11 Subdivision (b)(viii) Revocation or denial. 12 Subdivision (b)(i), Limitation, suspension, 13 (b)(iii), (b)(v), revocation, denial, 14 (b)(ix), probation, restitution, 15 (b)(x), or (b)(xi) community service, or fine. 16 Subdivision (c)(i) Denial, revocation, suspension, 17 probation, limitation, community 18 service, or fine. 19 Subdivision (c)(ii) Denial, suspension, revocation, 20 restitution, community service, 21 or fine. 04848'99 7 1 Subdivision (c)(iii) Probation, denial, suspension, 2 revocation, restitution, commu- 3 nity service, or fine. 4 Subdivision (c)(iv) Fine, probation, denial, 5 or restitution. 6 Subdivision (d)(i) Reprimand, fine, probation, 7 or (d)(ii) community service, denial, 8 or restitution. 9 Subdivision (e)(i) Reprimand, fine, probation, 10 limitation, suspension, community 11 service, denial, or restitution. 12 Subdivision (e)(ii) Reprimand, probation, 13 or (h) suspension, restitution, commu- 14 nity service, denial, or fine. 15 Subdivision (e)(iii) Reprimand, fine, probation, 16 or (e)(iv) suspension, revocation, limita- 17 tion, community service, denial, 18 or restitution. 19 Subdivision (f) Reprimand or fine. 04848'99 8 1 Subdivision (g) Reprimand, probation, denial, 2 suspension, revocation, 3 limitation, restitution, commu- 4 nity service, or fine. 5 Subdivision (i) Suspension or fine. 6 Subdivision (j), (o), or 7(q)(R) Reprimand or fine. 8 Subdivision (k) Reprimand, denial, or 9 limitation. 10 Subdivision (l) or (n) Denial, revocation, restitution, 11 probation, suspension, limita- 12 tion, reprimand, or fine. 13 Subdivision (m) Revocation or denial. 14 Subdivision (p) Revocation. 15 (2) Determination of sanctions for violations under this 16 section shall be made by a disciplinary subcommittee. If, during 17 judicial review, the court of appeals determines that a final 18 decision or order of a disciplinary subcommittee prejudices sub- 19 stantial rights of the petitioner for 1 or more of the grounds 20 listed in section 106 of the administrative procedures act of 21 1969, 1969 PA 306, MCL 24.306, and holds that the final decision 04848'99 9 1 or order is unlawful and is to be set aside, the court shall 2 state on the record the reasons for the holding and may remand 3 the case to the disciplinary subcommittee for further 4 consideration. 5 (3) A disciplinary subcommittee may impose a fine of up to, 6 but not exceeding, $250,000.00 for a violation of 7 section 16221(a) or (b). 8 (4) A disciplinary subcommittee may require a licensee or 9 registrant or an applicant for licensure or registration who has 10 violated this article or article 7 or a rule promulgated under 11 this article or article 7 to satisfactorily complete an educa- 12 tional program, a training program, or a treatment program, a 13 mental, physical, or professional competence examination, or a 14 combination of those programs and examinations. 15 SEC. 16279. (1) UPON RECEIPT OF A WRITTEN REQUEST FROM A 16 PATIENT, THE PATIENT'S AGENT, OR OTHER LEGALLY AUTHORIZED INDI- 17 VIDUAL TO EXAMINE OR COPY ALL OR PART OF THE INFORMATION CON- 18 TAINED IN THE PATIENT'S MEDICAL RECORD, A LICENSEE OR REGISTRANT 19 OR A PERSON AUTHORIZED BY THE LICENSEE OR REGISTRANT TO RETRIEVE 20 OR COPY, OR BOTH, MEDICAL RECORDS, AS PROMPTLY AS REQUIRED UNDER 21 THE CIRCUMSTANCES, BUT NOT LATER THAN 30 BUSINESS DAYS AFTER 22 RECEIPT OF THE WRITTEN REQUEST, SHALL DO 1 OR MORE OF THE FOLLOW- 23 ING, AS APPROPRIATE: 24 (A) MAKE THE MEDICAL RECORD AVAILABLE FOR EXAMINATION DURING 25 REGULAR BUSINESS HOURS AND PROVIDE A COPY, IF REQUESTED, TO THE 26 PATIENT, THE PATIENT'S AGENT, OR OTHER LEGALLY AUTHORIZED 27 INDIVIDUAL OF ALL OR PART OF THE MEDICAL RECORD, AS DETERMINED BY 04848'99 10 1 THE PATIENT, THE PATIENT'S AGENT, OR OTHER LEGALLY AUTHORIZED 2 INDIVIDUAL. 3 (B) IF THE MEDICAL RECORD DOES NOT EXIST OR CANNOT BE FOUND, 4 SO INFORM THE PATIENT, THE PATIENT'S AGENT, OR OTHER LEGALLY 5 AUTHORIZED INDIVIDUAL. 6 (C) IF THE LICENSEE OR REGISTRANT TO WHOM THE REQUEST IS 7 DIRECTED DOES NOT MAINTAIN THE MEDICAL RECORD, SO INFORM THE 8 PATIENT, THE PATIENT'S AGENT, OR OTHER LEGALLY AUTHORIZED INDI- 9 VIDUAL AND PROVIDE THE NAME AND ADDRESS, IF KNOWN, OF THE LICENS- 10 EE, REGISTRANT, HEALTH FACILITY OR AGENCY, OR OTHER ENTITY THAT 11 MAINTAINS THE MEDICAL RECORD. 12 (D) IF THE LICENSEE OR REGISTRANT IS UNAVAILABLE DURING THE 13 PERIOD OF 30 BUSINESS DAYS, UPON BECOMING AVAILABLE IMMEDIATELY 14 NOTIFY THE PATIENT, THE PATIENT'S AGENT, OR OTHER LEGALLY AUTHO- 15 RIZED INDIVIDUAL OF THE LICENSEE'S OR REGISTRANT'S RETURN AND 16 COMPLETE THE REQUEST PURSUANT TO THIS SUBSECTION WITHIN 30 BUSI- 17 NESS DAYS AFTER THE LICENSEE OR REGISTRANT BECOMES AVAILABLE. 18 (2) IF A PATIENT, THE PATIENT'S AGENT, OR OTHER LEGALLY 19 AUTHORIZED INDIVIDUAL REQUESTS TO EXAMINE OR COPY, OR BOTH, THE 20 INFORMATION CONTAINED IN THE PATIENT'S MEDICAL RECORD, THE 21 LICENSEE OR REGISTRANT OR A PERSON AUTHORIZED BY THE LICENSEE OR 22 REGISTRANT TO RETRIEVE OR COPY, OR BOTH, MEDICAL RECORDS MAY 23 CHARGE THE PATIENT, THE PATIENT'S AGENT, OR OTHER LEGALLY AUTHO- 24 RIZED INDIVIDUAL 1 OR MORE OF THE FOLLOWING: 25 (A) A RETRIEVAL FEE NOT TO EXCEED $15.00 PER REQUEST. 26 (B) SUBJECT TO SUBSECTION (4), IF THE LICENSEE OR REGISTRANT 27 OR A PERSON AUTHORIZED BY THE LICENSEE OR REGISTRANT TO RETRIEVE 04848'99 11 1 OR COPY, OR BOTH, MEDICAL RECORDS COPIES THE MEDICAL RECORD FOR 2 THE PATIENT, THE PATIENT'S AGENT, OR OTHER LEGALLY AUTHORIZED 3 INDIVIDUAL AND IF THE NUMBER OF PAGES TO BE COPIED DOES NOT 4 EXCEED 20, A COPYING FEE OF NOT MORE THAN $1.00 PER PAGE. 5 (C) SUBJECT TO SUBSECTION (4), IF THE LICENSEE OR REGISTRANT 6 OR A PERSON AUTHORIZED BY THE LICENSEE OR REGISTRANT TO RETRIEVE 7 OR COPY, OR BOTH, MEDICAL RECORDS COPIES THE MEDICAL RECORD FOR 8 THE PATIENT, THE PATIENT'S AGENT, OR OTHER LEGALLY AUTHORIZED 9 INDIVIDUAL AND IF THE NUMBER OF PAGES IS MORE THAN 20, BUT FEWER 10 THAN 60, A COPYING FEE OF NOT MORE THAN 75 CENTS PER PAGE. 11 (D) SUBJECT TO SUBSECTION (4), IF THE LICENSEE OR REGISTRANT 12 OR A PERSON AUTHORIZED BY THE LICENSEE OR REGISTRANT TO RETRIEVE 13 OR COPY, OR BOTH, MEDICAL RECORDS COPIES THE MEDICAL RECORD FOR 14 THE PATIENT, THE PATIENT'S AGENT, OR OTHER LEGALLY AUTHORIZED 15 INDIVIDUAL AND IF THE NUMBER OF PAGES IS MORE THAN 60, A COPYING 16 FEE OF NOT MORE THAN 25 CENTS PER PAGE. 17 (E) IF THE LICENSEE OR REGISTRANT OR A PERSON AUTHORIZED BY 18 THE LICENSEE OR REGISTRANT TO RETRIEVE OR COPY, OR BOTH, MEDICAL 19 RECORDS COPIES THE MEDICAL RECORD UPON THE REQUEST OF A PROSECUT- 20 ING ATTORNEY, THE LICENSEE OR REGISTRANT OR PERSON AUTHORIZED BY 21 THE LICENSEE OR REGISTRANT TO RETRIEVE OR COPY, OR BOTH, MEDICAL 22 RECORDS MAY CHARGE A RETRIEVAL FEE OF NOT MORE THAN $15.00 PLUS 23 THE ACTUAL COST OF DELIVERY. 24 (F) IF THE LICENSEE OR REGISTRANT OR A PERSON AUTHORIZED BY 25 THE LICENSEE OR REGISTRANT TO RETRIEVE OR COPY, OR BOTH, MEDICAL 26 RECORDS COPIES THE MEDICAL RECORD UPON THE REQUEST OF A STATE 27 EXECUTIVE AGENCY, THE LICENSEE OR REGISTRANT OR PERSON AUTHORIZED 04848'99 12 1 BY THE LICENSEE OR REGISTRANT TO RETRIEVE OR COPY, OR BOTH, 2 MEDICAL RECORDS MAY NOT CHARGE A RETRIEVAL FEE OR ANY OTHER FEE, 3 UNLESS SUCH A FEE IS PERMITTED UNDER STATE EXECUTIVE AGENCY RULE 4 OR GUIDELINES. 5 (G) IF THE LICENSEE OR REGISTRANT OR A PERSON AUTHORIZED BY 6 THE LICENSEE OR REGISTRANT TO RETRIEVE OR COPY, OR BOTH, MEDICAL 7 RECORDS COPIES THE MEDICAL RECORD FOR THE PURPOSE OF SUPPORTING A 8 CLAIM FOR MEDICARE, MEDICAID, OR OTHER NEED-BASED PROGRAMS, AND 9 THE PURPOSE OF THE REQUEST IS CLEARLY SHOWN BY THE PARTY MAKING 10 THE REQUEST, THE LICENSEE OR REGISTRANT MAY CHARGE A RETRIEVAL 11 FEE OF NOT MORE THAN $25.00 PLUS THE ACTUAL COST OF DELIVERY. 12 (3) A LICENSEE OR REGISTRANT OR A PERSON AUTHORIZED BY THE 13 LICENSEE OR REGISTRANT TO RETRIEVE OR COPY, OR BOTH, MEDICAL 14 RECORDS MAY REFUSE TO RETRIEVE OR COPY A MEDICAL RECORD FOR A 15 PATIENT OR PATIENT'S AGENT UNTIL THE APPLICABLE FEE UNDER THIS 16 SECTION IS PAID. 17 (4) THE COPYING CHARGE LIMIT SET FORTH IN SUBSECTION (2) 18 DOES NOT APPLY TO COPIES OF MICROFILM, X-RAYS, ELECTROENCEPHALO- 19 GRAM TRACINGS, OR OTHER RADIOGRAPHIC OR PHOTOGRAPHIC RECORDS. A 20 LICENSEE OR REGISTRANT OR A PERSON AUTHORIZED BY THE LICENSEE OR 21 REGISTRANT TO RETRIEVE OR COPY, OR BOTH, MEDICAL RECORDS MAY 22 CHARGE THE ACTUAL COST OF COPYING A MEDICAL RECORD DESCRIBED IN 23 THIS SUBSECTION. 24 (5) A LICENSEE OR REGISTRANT OR A PERSON AUTHORIZED BY THE 25 LICENSEE OR REGISTRANT TO RETRIEVE OR COPY, OR BOTH, MEDICAL 26 RECORDS MAY CHARGE THE ACTUAL COSTS OF SHIPPING AND DELIVERY FOR 04848'99 13 1 MEDICAL RECORDS COPIED, SHIPPED, AND DELIVERED UNDER THIS 2 SECTION. 3 (6) BEGINNING UPON THE EXPIRATION OF 1 YEAR AFTER THE EFFEC- 4 TIVE DATE OF THE AMENDATORY ACT THAT ADDED THIS SECTION, THE 5 DIRECTOR OF THE DEPARTMENT OF CONSUMER AND INDUSTRY SERVICES MAY 6 ANNUALLY ADJUST THE DOLLAR AND CENTS PER PAGE LIMITS SET FORTH IN 7 SUBSECTION (2) BY AN AMOUNT DETERMINED BY THE STATE TREASURER TO 8 REFLECT THE ANNUAL PERCENTAGE CHANGE IN THE DETROIT CONSUMER 9 PRICE INDEX. 10 (7) THE DIRECTOR OF THE DEPARTMENT OF CONSUMER AND INDUSTRY 11 SERVICES SHALL DEVELOP A MODEL REQUEST FORM FOR PURPOSES OF THIS 12 SECTION AND MAKE THE FORM AVAILABLE UPON REQUEST TO LICENSEES, 13 REGISTRANTS, AND OTHER INDIVIDUALS INCLUDING, BUT NOT LIMITED TO, 14 A PERSON AUTHORIZED BY A LICENSEE OR REGISTRANT TO RETRIEVE OR 15 COPY, OR BOTH, MEDICAL RECORDS. 16 (8) AS USED IN THIS SECTION: 17 (A) "DETROIT CONSUMER PRICE INDEX" MEANS THE MOST COMPREHEN- 18 SIVE INDEX OF CONSUMER PRICES AVAILABLE FOR THE DETROIT AREA FROM 19 THE BUREAU OF LABOR STATISTICS OF THE UNITED STATES DEPARTMENT OF 20 LABOR. 21 (B) "MEDICAID" MEANS THE PROGRAM FOR MEDICAL ASSISTANCE CRE- 22 ATED UNDER TITLE XIX AND ADMINISTERED BY THE DEPARTMENT OF COMMU- 23 NITY HEALTH UNDER THE SOCIAL WELFARE ACT, 1939 PA 280, MCL 400.1 24 TO 400.119B. AS USED IN THIS SUBDIVISION, "TITLE XIX" MEANS THAT 25 TERM AS DEFINED IN SECTION 20201(3)(E). 26 (C) "MEDICAL RECORD" INCLUDES, BUT IS NOT LIMITED TO, 27 MEDICAL HISTORIES, RECORDS, REPORTS, SUMMARIES, DIAGNOSES AND 04848'99 14 1 PROGNOSES, TREATMENT AND MEDICATION ORDERED AND GIVEN, NOTES, 2 ENTRIES, AND X-RAYS AND OTHER IMAGING RECORDS. MEDICAL RECORD 3 DOES NOT INCLUDE MENTAL HEALTH RECORDS. 4 (D) "MEDICARE" MEANS BENEFITS UNDER THE FEDERAL MEDICARE 5 PROGRAM ESTABLISHED UNDER TITLE XVIII. AS USED IN THIS SUBDIVI- 6 SION, "TITLE XVIII" MEANS THAT TERM AS DEFINED IN SECTION 7 20201(3)(E). 8 (E) "MENTAL HEALTH RECORD" MEANS INFORMATION THAT IS 9 DESCRIBED AND MADE CONFIDENTIAL UNDER SECTION 748 OF THE MENTAL 10 HEALTH CODE, 1974 PA 258, MCL 330.1748. 11 (F) "PATIENT'S AGENT" OR "AGENT" MEANS 1 OR MORE OF THE 12 FOLLOWING: 13 (i) A LEGAL GUARDIAN OF THE PATIENT. 14 (ii) IF THE PATIENT IS A MINOR, A PARENT OR LEGAL GUARDIAN 15 OF THE MINOR. 16 (iii) A LEGAL REPRESENTATIVE OF THE PATIENT. 17 Sec. 20165. (1) Except as otherwise provided in this sec- 18 tion, after notice of intent to an applicant or licensee to deny, 19 limit, suspend, or revoke the applicant's or licensee's license 20 or certification and an opportunity for a hearing, the department 21 may deny, limit, suspend, or revoke the license or certification 22 or impose an administrative fine on a licensee if 1 or more of 23 the following exist: 24 (a) Fraud or deceit in obtaining or attempting to obtain a 25 license or certification or in the operation of the licensed 26 health facility or agency. 04848'99 15 1 (b) A violation of this article or a rule promulgated under 2 this article. 3 (c) False or misleading advertising. 4 (d) Negligence or failure to exercise due care, including 5 negligent supervision of employees and subordinates. 6 (e) Permitting a license or certificate to be used by an 7 unauthorized health facility or agency. 8 (f) Evidence of abuse regarding a patient's health, welfare, 9 or safety or the denial of a patient's rights. 10 (g) Failure to comply with section 10102a(7). 11 (h) Failure to comply with part 222 or a term, condition, or 12 stipulation of a certificate of need issued under part 222, or 13 both. 14 (i) A violation of section 20197(1). 15 (2) The department may deny an application for a license or 16 certification based on a finding of a condition or practice that 17 would constitute a violation of this article if the applicant 18 were a licensee. 19 (3) Denial, suspension, or revocation of an individual emer- 20 gency medical services personnel license under part 209 is gov- 21 erned by section 20958. 22 (4) If the department determines under subsection (1) that a 23 health facility or agency has violated section 20197(1), the 24 department shall impose an administrative fine of $5,000,000.00 25 on the health facility or agency. 26 (5) IF, AFTER NOTICE AND THE OPPORTUNITY FOR A HEARING, THE 27 DEPARTMENT DETERMINES THAT A HEALTH FACILITY OR AGENCY OR A 04848'99 16 1 PERSON AUTHORIZED BY THE HEALTH FACILITY OR AGENCY TO RETRIEVE OR 2 COPY, OR BOTH, MEDICAL RECORDS HAS VIOLATED SECTION 20195, THE 3 DEPARTMENT SHALL IMPOSE AN ADMINISTRATIVE FINE ON THE HEALTH 4 FACILITY OR AGENCY. 5 SEC. 20195. (1) UPON RECEIPT OF A WRITTEN REQUEST FROM A 6 PATIENT, THE PATIENT'S AGENT, OR OTHER LEGALLY AUTHORIZED INDI- 7 VIDUAL TO EXAMINE OR COPY, OR BOTH, ALL OR PART OF THE INFORMA- 8 TION CONTAINED IN THE PATIENT'S MEDICAL RECORD, A HEALTH FACILITY 9 OR AGENCY OR A PERSON AUTHORIZED BY THE HEALTH FACILITY OR AGENCY 10 TO RETRIEVE OR COPY, OR BOTH, MEDICAL RECORDS, AS PROMPTLY AS 11 REQUIRED UNDER THE CIRCUMSTANCES, BUT NOT LATER THAN 30 BUSINESS 12 DAYS AFTER RECEIPT OF THE WRITTEN REQUEST, SHALL DO 1 OR MORE OF 13 THE FOLLOWING, AS APPROPRIATE: 14 (A) MAKE THE MEDICAL RECORD AVAILABLE FOR EXAMINATION DURING 15 REGULAR BUSINESS HOURS AND PROVIDE A COPY, IF REQUESTED, TO THE 16 PATIENT, THE PATIENT'S AGENT, OR OTHER LEGALLY AUTHORIZED INDI- 17 VIDUAL OF ALL OR PART OF THE MEDICAL RECORD, AS DETERMINED BY THE 18 PATIENT, THE PATIENT'S AGENT, OR OTHER LEGALLY AUTHORIZED 19 INDIVIDUAL. 20 (B) IF THE MEDICAL RECORD DOES NOT EXIST OR CANNOT BE FOUND, 21 SO INFORM THE PATIENT, THE PATIENT'S AGENT, OR OTHER LEGALLY 22 AUTHORIZED INDIVIDUAL. 23 (C) IF THE HEALTH FACILITY OR AGENCY TO WHOM THE REQUEST IS 24 DIRECTED DOES NOT MAINTAIN THE MEDICAL RECORD, SO INFORM THE 25 PATIENT, THE PATIENT'S AGENT, OR OTHER LEGALLY AUTHORIZED INDI- 26 VIDUAL AND PROVIDE THE NAME AND ADDRESS, IF KNOWN, OF THE HEALTH 04848'99 17 1 PROFESSIONAL, HEALTH FACILITY OR AGENCY, OR OTHER ENTITY THAT 2 MAINTAINS THE MEDICAL RECORD. 3 (2) IF A PATIENT, THE PATIENT'S AGENT, OR OTHER LEGALLY 4 AUTHORIZED INDIVIDUAL REQUESTS TO EXAMINE OR COPY, OR BOTH, THE 5 PATIENT'S MEDICAL RECORD, THE HEALTH FACILITY OR AGENCY OR A 6 PERSON AUTHORIZED BY THE HEALTH FACILITY OR AGENCY TO RETRIEVE OR 7 COPY, OR BOTH, MEDICAL RECORDS MAY CHARGE THE PATIENT, THE 8 PATIENT'S AGENT, OR OTHER LEGALLY AUTHORIZED INDIVIDUAL 1 OR MORE 9 OF THE FOLLOWING: 10 (A) A RETRIEVAL FEE NOT TO EXCEED $15.00 PER REQUEST. 11 (B) SUBJECT TO SUBSECTION (4), IF THE HEALTH FACILITY OR 12 AGENCY OR A PERSON AUTHORIZED BY THE HEALTH FACILITY OR AGENCY TO 13 RETRIEVE OR COPY, OR BOTH, MEDICAL RECORDS COPIES THE MEDICAL 14 RECORD FOR THE PATIENT, THE PATIENT'S AGENT, OR OTHER LEGALLY 15 AUTHORIZED INDIVIDUAL AND IF THE NUMBER OF PAGES TO BE COPIED 16 DOES NOT EXCEED 20, A COPYING FEE OF NOT MORE THAN $1.00 PER 17 PAGE. 18 (C) SUBJECT TO SUBSECTION (4), IF THE HEALTH FACILITY OR 19 AGENCY OR A PERSON AUTHORIZED BY THE HEALTH FACILITY OR AGENCY TO 20 RETRIEVE OR COPY, OR BOTH, MEDICAL RECORDS COPIES THE MEDICAL 21 RECORD FOR THE PATIENT, THE PATIENT'S AGENT, OR OTHER LEGALLY 22 AUTHORIZED INDIVIDUAL AND IF THE NUMBER OF PAGES IS MORE THAN 20, 23 BUT FEWER THAN 60, A COPYING FEE OF NOT MORE THAN 75 CENTS PER 24 PAGE. 25 (D) SUBJECT TO SUBSECTION (4), IF THE HEALTH FACILITY OR 26 AGENCY OR A PERSON AUTHORIZED BY THE HEALTH FACILITY OR AGENCY TO 27 RETRIEVE OR COPY, OR BOTH, MEDICAL RECORDS COPIES THE MEDICAL 04848'99 18 1 RECORDS FOR THE PATIENT, THE PATIENT'S AGENT, OR OTHER LEGALLY 2 AUTHORIZED INDIVIDUAL AND IF THE NUMBER OF PAGES IS MORE THAN 60, 3 A COPYING FEE OF NOT MORE THAN 25 CENTS PER PAGE. 4 (E) IF THE HEALTH FACILITY OR AGENCY OR A PERSON AUTHORIZED 5 BY THE HEALTH FACILITY OR AGENCY TO RETRIEVE OR COPY, OR BOTH, 6 MEDICAL RECORDS COPIES THE MEDICAL RECORD UPON THE REQUEST OF A 7 PROSECUTING ATTORNEY, THE HEALTH FACILITY OR AGENCY OR PERSON 8 AUTHORIZED BY THE HEALTH FACILITY OR AGENCY TO RETRIEVE OR COPY, 9 OR BOTH, MEDICAL RECORDS MAY CHARGE A RETRIEVAL FEE OF NOT MORE 10 THAN $15.00 PLUS THE ACTUAL COST OF DELIVERY. 11 (F) IF THE HEALTH FACILITY OR AGENCY OR A PERSON AUTHORIZED 12 BY THE HEALTH FACILITY OR AGENCY TO RETRIEVE OR COPY, OR BOTH, 13 MEDICAL RECORDS COPIES THE MEDICAL RECORD UPON THE REQUEST OF A 14 STATE EXECUTIVE AGENCY, THE HEALTH FACILITY OR AGENCY OR PERSON 15 AUTHORIZED BY THE HEALTH FACILITY OR AGENCY TO RETRIEVE OR COPY, 16 OR BOTH, MEDICAL RECORDS MAY NOT CHARGE A RETRIEVAL FEE OR ANY 17 OTHER FEE, UNLESS SUCH A FEE IS PERMITTED UNDER STATE EXECUTIVE 18 AGENCY RULE OR GUIDELINES. 19 (G) IF THE HEALTH FACILITY OR AGENCY OR A PERSON AUTHORIZED 20 BY THE HEALTH FACILITY OR AGENCY TO RETRIEVE OR COPY, OR BOTH, 21 MEDICAL RECORDS COPIES THE MEDICAL RECORD FOR THE PURPOSE OF SUP- 22 PORTING A CLAIM FOR MEDICARE, MEDICAID, OR OTHER NEED-BASED PRO- 23 GRAMS, AND THE PURPOSE OF THE REQUEST IS CLEARLY SHOWN BY THE 24 PARTY MAKING THE REQUEST, THE HEALTH FACILITY OR AGENCY OR PERSON 25 AUTHORIZED BY THE HEALTH FACILITY OR AGENCY TO RETRIEVE OR COPY, 26 OR BOTH, MEDICAL RECORDS MAY CHARGE A RETRIEVAL FEE OF NOT MORE 27 THAN $25.00 PLUS THE ACTUAL COST OF DELIVERY. 04848'99 19 1 (3) A HEALTH FACILITY OR AGENCY OR A PERSON AUTHORIZED BY 2 THE HEALTH FACILITY OR AGENCY TO RETRIEVE OR COPY, OR BOTH, MEDI- 3 CAL RECORDS MAY CHARGE A FEE UNDER SUBSECTION (2) ONLY FOR THAT 4 PART OF THE MEDICAL RECORD ACTUALLY RETRIEVED OR COPIED, OR 5 BOTH. A HEALTH FACILITY OR AGENCY OR A PERSON AUTHORIZED BY THE 6 HEALTH FACILITY OR AGENCY TO RETRIEVE OR COPY, OR BOTH, MEDICAL 7 RECORDS MAY REFUSE TO RETRIEVE OR COPY A MEDICAL RECORD FOR A 8 PATIENT, PATIENT'S AGENT, OR OTHER LEGALLY AUTHORIZED INDIVIDUAL 9 UNTIL THE APPLICABLE FEE IS PAID. 10 (4) THE COPYING CHARGE LIMIT SET FORTH IN SUBSECTION (2) 11 DOES NOT APPLY TO COPIES OF MICROFILM, X-RAYS, ELECTROENCEPHALO- 12 GRAM TRACINGS, OR OTHER IMAGING OR PHOTOGRAPHIC RECORDS. A 13 HEALTH FACILITY OR AGENCY OR A PERSON AUTHORIZED BY THE HEALTH 14 FACILITY OR AGENCY TO RETRIEVE OR COPY, OR BOTH, MEDICAL RECORDS 15 MAY CHARGE THE ACTUAL COST OF COPYING A MEDICAL RECORD DESCRIBED 16 IN THIS SUBSECTION. 17 (5) A HEALTH FACILITY OR AGENCY OR A PERSON AUTHORIZED BY 18 THE HEALTH FACILITY OR AGENCY TO RETRIEVE OR COPY, OR BOTH, MEDI- 19 CAL RECORDS MAY CHARGE THE ACTUAL COSTS OF SHIPPING AND DELIVERY 20 FOR MEDICAL RECORDS COPIED, SHIPPED, AND DELIVERED UNDER THIS 21 SECTION. 22 (6) THE DIRECTOR OF THE DEPARTMENT OF CONSUMER AND INDUSTRY 23 SERVICES MAY ANNUALLY ADJUST THE DOLLAR OR CENTS PER PAGE LIMIT 24 SET FORTH IN SUBSECTION (2) BY AN AMOUNT DETERMINED BY THE STATE 25 TREASURER TO REFLECT THE ANNUAL PERCENTAGE CHANGE IN THE DETROIT 26 CONSUMER PRICE INDEX. 04848'99 20 1 (7) THE DIRECTOR OF THE DEPARTMENT OF CONSUMER AND INDUSTRY 2 SERVICES SHALL DEVELOP A MODEL REQUEST FORM FOR PURPOSES OF THIS 3 SECTION AND MAKE THE FORM AVAILABLE UPON REQUEST TO A HEALTH 4 FACILITY OR AGENCY OR A PERSON AUTHORIZED BY THE HEALTH FACILITY 5 OR AGENCY TO RETRIEVE OR COPY, OR BOTH, MEDICAL RECORDS OR TO AN 6 INDIVIDUAL. 7 (8) IN ADDITION TO THE SANCTIONS SET FORTH IN SECTION 20165, 8 A HEALTH FACILITY OR AGENCY THAT VIOLATES THIS SECTION IS SUBJECT 9 TO A REPRIMAND OR TO AN ADMINISTRATIVE FINE OF NOT MORE THAN 10 $1,000.00 FOR EACH VIOLATION. 11 (9) AS USED IN THIS SECTION: 12 (A) "DETROIT CONSUMER PRICE INDEX" MEANS THE MOST COMPREHEN- 13 SIVE INDEX OF CONSUMER PRICES AVAILABLE FOR THE DETROIT AREA FROM 14 THE BUREAU OF LABOR STATISTICS OF THE UNITED STATES DEPARTMENT OF 15 LABOR. 16 (B) "MEDICAID" MEANS THE PROGRAM FOR MEDICAL ASSISTANCE CRE- 17 ATED UNDER TITLE XIX AND ADMINISTERED BY THE DEPARTMENT OF COMMU- 18 NITY HEALTH UNDER THE SOCIAL WELFARE ACT, 1939 PA 280, MCL 400.1 19 TO 400.119B. AS USED IN THIS SUBDIVISION, "TITLE XIX" MEANS THAT 20 TERM AS DEFINED IN SECTION 20201(3)(E). 21 (C) "MEDICAL RECORD" INCLUDES, BUT IS NOT LIMITED TO, MEDI- 22 CAL HISTORIES, RECORDS, REPORTS, SUMMARIES, DIAGNOSES AND PRO- 23 GNOSES, TREATMENT AND MEDICATION ORDERED AND GIVEN, NOTES, 24 ENTRIES, AND X-RAYS AND OTHER RADIOGRAPHIC OR PHOTOGRAPHIC 25 RECORDS. MEDICAL RECORD DOES NOT INCLUDE MENTAL HEALTH RECORDS. 26 (D) "MEDICARE" MEANS BENEFITS UNDER THE FEDERAL MEDICARE 27 PROGRAM ESTABLISHED UNDER TITLE XVIII. AS USED IN THIS 04848'99 21 1 SUBDIVISION, "TITLE XVIII" MEANS THAT TERM AS DEFINED IN SECTION 2 20201(3)(E). 3 (E) "MENTAL HEALTH RECORD" MEANS INFORMATION THAT IS 4 DESCRIBED AND MADE CONFIDENTIAL UNDER SECTION 748 OF THE MENTAL 5 HEALTH CODE, 1974 PA 258, MCL 330.1748. 6 (F) "PATIENT'S AGENT" MEANS 1 OR MORE OF THE FOLLOWING: 7 (i) A LEGAL GUARDIAN OF THE PATIENT. 8 (ii) IF THE PATIENT IS A MINOR, A PARENT OR LEGAL GUARDIAN 9 OF THE MINOR. 10 (iii) A LEGAL REPRESENTATIVE OF THE PATIENT. 11 Sec. 20201. (1)ASUBJECT TO SECTION 20203, A health 12 facility or agencywhichTHAT provides services directly to 13 patients or residents andwhichis licensed under this article 14 shall adopt a policy describing the rights and responsibilities 15 of patients or residents admitted to the health facility or 16 agency. Except for a licensed health maintenance organization 17which shallTHAT IS REQUIRED TO comply with section 21086,the18policy shall be postedA HEALTH FACILITY OR AGENCY SHALL POST 19 THE POLICY at a public place in the HEALTH facility OR AGENCY and 20 shallbe providedPROVIDE A COPY OF THE POLICY to each member 21 ofthe facilityITS staff.PatientsA HEALTH FACILITY OR 22 AGENCY SHALL TREAT PATIENTS or residentsshall be treatedin 23 accordance with the policy. 24 (2) The policy REQUIRED UNDER SUBSECTION (1) describing the 25 rights and responsibilities of patients or residents shall 26 include,asAT a minimum, ALL OF THE FOLLOWING: 04848'99 22 1 (a) A patient or resident will not be denied appropriate 2 care on the basis of race, religion, color, national origin, sex, 3 age, handicap, marital status, sexual preference, or source of 4 payment. 5 (b) An individual who is or has been a patient or resident 6 is entitled to inspect, or receive for a reasonable fee, aAND 7 TO copyofhis or her medical record upon request, PURSUANT TO 8 SECTION 20195. A third party shall not be given a copy of the 9 patient's or resident's medical record without prior authoriza- 10 tion of the patient. 11 (c) A patient or resident is entitled to confidential treat- 12 ment of personal and medical records, and may refuse their 13 release to a person outside the facility except as required 14 because of a transfer to another health care facility or as 15 required by law or third party payment contract. 16 (d) A patient or resident is entitled to privacy, to the 17 extent feasible, in treatment and in caring for personal needs 18 with consideration, respect, and full recognition of his or her 19 dignity and individuality. 20 (e) A patient or resident is entitled to receive adequate 21 and appropriate care, and to receive, from the appropriate indi- 22 vidual within the HEALTH facility OR AGENCY, information about 23 his or her medical condition, proposed course of treatment, and 24 prospects for recovery, in terms that the patient or resident can 25 understand, unless medically contraindicated as documented by the 26 attending physician in the PATIENT'S OR RESIDENT'S medical 27 record. 04848'99 23 1 (f) A patient or resident is entitled to refuse treatment to 2 the extent provided by law and to be informed of the consequences 3 of that refusal. When a refusal of treatment prevents a health 4 facility OR AGENCY or its staff from providing appropriate care 5 according to ethical and professional standards, the relationship 6 with the patient or resident may be terminated upon reasonable 7 notice. 8 (g) A patient or resident is entitled to exercise his or her 9 rights as a patient or resident and as a citizen, and to this end 10 may present grievances or recommend changes in policies and serv- 11 ices on behalf of himself or herself or others to the HEALTH 12 facility OR AGENCY staff, to governmental officials, or to 13 another person of his or her choice within or outside the HEALTH 14 facility OR AGENCY, free from restraint, interference, coercion, 15 discrimination, or reprisal. A patient or resident is entitled 16 to information about the HEALTH facility's OR AGENCY'S policies 17 and procedures for initiation, review, and resolution of patient 18 or resident complaints. 19 (h) A patient or resident is entitled to information con- 20 cerning an experimental procedure proposed as a part of his or 21 her care andshall haveHAS the right to refuse to participate 22 in the experiment without jeopardizing his or her continuing 23 care. 24 (i) A patient or resident is entitled to receive and examine 25 an explanation of his or her bill regardless of the source of 26 payment and to receive, upon request, information relating to 04848'99 24 1 financial assistance available through the HEALTH facility OR 2 AGENCY. 3 (j) A patient or resident is entitled to know who is respon- 4 sible for and who is providing his or her direct care, is enti- 5 tled to receive information concerning his or her continuing 6 health needs and alternatives for meeting those needs, and to be 7 involved in his or her discharge planning, if appropriate. 8 (k) A patient or resident is entitled to associate and have 9 private communications and consultations with his or her physi- 10 cian, attorney, or any other person of his or her choice and to 11 send and receive personal mail unopened on the same day it is 12 received at the health facility or agency, unless medically con- 13 traindicated as documented by the attending physician in the 14 PATIENT'S OR RESIDENT'S medical record. A patient's or 15 resident's civil and religious liberties, including the right to 16 independent personal decisions and the right to knowledge of 17 available choices, shall not be infringed and the HEALTH facility 18 OR AGENCY shall encourage and assist in the fullest possible 19 exercise of these rights. A patient or resident may meet with, 20 and participate in, the activities of social, religious, and com- 21 munity groups at his or her discretion, unless medically contra- 22 indicated as documented by the attending physician in the 23 PATIENT'S OR RESIDENT'S medical record. 24 (l) A patient or resident is entitled to be free from mental 25 and physical abuse and from physical and chemical restraints, 26 except those restraints authorized in writing by the attending 27 physician for a specified and limited time or as are necessitated 04848'99 25 1 by an emergency to protect the patient or resident from injury to 2 self or others, in which case the restraint may only be applied 3 by a qualified professional who shall set forth in writing the 4 circumstances requiring the use of restraints and who shall 5 promptly report the action to the attending physician. In case 6 of a chemical restraint a physician shall be consulted within 24 7 hours after the commencement of the restraint. 8 (m) A patient or resident is entitled to be free from per- 9 forming services for the HEALTH facility OR AGENCY that are not 10 included for therapeutic purposes in the plan of care. 11 (n) A patient or resident is entitled to information about 12 the health facility OR AGENCY rules and regulations affecting 13 patient or resident care and conduct. 14 (3) The following additional requirements for the policy 15described in subsection (2) shallREQUIRED UNDER SUBSECTION (1) 16 apply to licensees under parts 213 and 217: 17 (a) The policy shall be provided to each nursing home 18 patient or home for the aged resident upon admission, and the 19 staff of thefacilityNURSING HOME OR HOME FOR THE AGED shall 20 be trained and involved in the implementation of the policy. 21 (b) Each nursing home patient may associate and communicate 22 privately with persons of his or her choice. Reasonable, regular 23 visiting hours, which shall be not less than 8 hours per day, and 24 which shall take into consideration the special circumstances of 25 each visitor, shall be established for patients to receive 26 visitors. A NURSING HOME patient may be visited by the patient's 27 attorney or by representatives of the departments named in 04848'99 26 1 section 20156, during other than established visiting hours. 2 Reasonable privacy shall be afforded for visitation of a NURSING 3 HOME patient who shares a room with another NURSING HOME 4 patient. Each NURSING HOME patient shall have reasonable access 5 to a telephone. A married nursing home patient or home for the 6 aged resident is entitled to meet privately with his or her 7 spouse in a room which assures privacy. If both spouses are 8 PATIENTS OR residents in the samefacilityNURSING HOME OR HOME 9 FOR THE AGED, they are entitled to share a room unless medically 10 contraindicated and documented by the attending physician in the 11 PATIENT'S OR RESIDENT'S medical record. 12 (c) A nursing home patient or home for the aged resident is 13 entitled to retain and use personal clothing and possessions as 14 space permits, unless to do so would infringe upon the rights of 15 other NURSING HOME patients or HOME FOR THE AGED residents, or 16 unless medically contraindicated as documented by the attending 17 physician in the PATIENT'S OR RESIDENT'S medical record. Each 18 nursing home patient or home for the aged resident shall be pro- 19 vided with reasonable space. At the request of a NURSING HOME 20 patient, a nursing home shall provide for the safekeeping of per- 21 sonal effects, funds, and other property of a patient in accord- 22 ance with section 21767, except that a nursing homeshall not23beIS NOT required to provide for the safekeeping of a property 24 which would impose an unreasonable burden on the nursing home. 25 (d) A nursing home patient or home for the aged resident is 26 entitled to the opportunity to participate in the planning of his 27 or her medical treatment. A nursing home patient shall be fully 04848'99 27 1 informed by the attending physician of the patient's medical 2 condition unless medically contraindicated as documented by a 3 physician in the PATIENT'S medical record. Each nursing home 4 patient shall be afforded the opportunity to discharge himself or 5 herself from the nursing home. 6 (e) A home for the aged resident may be transferred or dis- 7 charged only for medical reasons, for his or her welfare or that 8 of other residents, or for nonpayment of his or her stay, except 9 as provided bytitle 18 or 19 of the social security act, 4210U.S.C. 1395 to 1396kTITLE XVIII OR TITLE XIX. A nursing home 11 patient may be transferred or discharged only as provided in sec- 12 tions 21773 to 21777. A nursing home patient or home for the 13 aged resident is entitled to be given reasonable advance notice 14 to ensure orderly transfer or discharge.Those actionsSTEPS 15 TAKEN TO ENSURE REASONABLE ADVANCE NOTICE shall be documented in 16 the PATIENT'S OR RESIDENT'S medical record. AS USED IN THIS SUB- 17 DIVISION AND SUBDIVISION (F): 18 (i) "TITLE XVIII" MEANS TITLE XVIII OF THE SOCIAL SECURITY 19 ACT, CHAPTER 531, 49 STAT. 620, 42 U.S.C. 1395 TO 1395b, 1395b-2, 20 1395b-6 TO 1395b-7, 1395c TO 1395i, 1395i-2 TO 1395i-5, 1395j TO 21 1395t, 1395u TO 1395w, 1395w-2 TO 1395w-4, 1395w-21 TO 1395w-28, 22 1395x TO 1395yy, AND 1395bbb TO 1395ggg. 23 (ii) "TITLE XIX" MEANS TITLE XIX OF THE SOCIAL SECURITY ACT, 24 CHAPTER 531, 49 STAT. 620, 42 U.S.C. 1396 TO 1396f AND 1396g-1 TO 25 1396r-6, AND 1396r-8 TO 1396v. 26 (f) A nursing home patient or home for the aged resident is 27 entitled to be fully informed before or at the time of admission 04848'99 28 1 and during stay of services available in thefacilityNURSING 2 HOME OR HOME FOR THE AGED, and of the related charges including 3 any charges for services not covered undertitle 18 or 19 of the4social security act, 42 U.S.C. 1395 to 1396kTITLE XVIII OR 5 TITLE XIX, or not covered by thefacility'sNURSING HOME'S OR 6 HOME FOR THE AGED'S basic per diem rate. The statement of serv- 7 ices provided by thefacilityNURSING HOME OR HOME FOR THE AGED 8 shall be in writing and shall include those required to be 9 offered on an as-needed basis. 10 (g) A nursing home patient or home for the aged resident is 11 entitled to manage his or her own financial affairs, or to have 12 at least a quarterly accounting of personal financial transac- 13 tions undertaken in his or her behalf by thefacilityNURSING 14 HOME OR HOME FOR THE AGED during a period of time the patient or 15 resident has delegated those responsibilities to thefacility16 NURSING HOME OR HOME FOR THE AGED. In addition, a NURSING HOME 17 patient or HOME FOR THE AGED resident is entitled to receive each 18 month from thefacilityNURSING HOME OR HOME FOR THE AGED an 19 itemized statement setting forth the services paid for by or on 20 behalf of the patient and the services rendered by thefacility21 NURSING HOME OR HOME FOR THE AGED. The admission of a patient to 22 a nursing home does not confer on the nursing home or its owner, 23 administrator, employees, or representatives the authority to 24 manage, use, or dispose ofaTHE patient's property. 25 (h) A nursing home patient or a person authorized byaTHE 26 patient in writing may inspect and copy the patient's personal 27 RECORDS UNDER THIS SUBDIVISION and MAY INSPECT AND COPY THE 04848'99 29 1 PATIENT'S medical records PURSUANT TO SECTION 20195. The 2 PERSONAL records shall be made available for inspection and copy- 3 ing by the nursing home within a reasonable time, not exceeding 1 4 week, after the receipt of a written request UNDER THIS 5 SUBDIVISION. 6 (i) If a nursing home patient desires treatment by a 7 licensed member of the healing arts, the treatment shall be made 8 available unless it is medically contraindicated, and the medical 9 contraindication is justified in the patient's medical record by 10 the attending physician. 11 (j) A nursing home patient has the right to have his or her 12 parents, if a minor, or his or her spouse, next of kin, or 13 patient's representative, if an adult, stay at the facility 24 14 hours a day if the patient is considered terminally ill by the 15 physician responsible for the patient's care. 16 (k) Each nursing home patient shall be provided with meals 17 which meet the recommended dietary allowances for that patient's 18 age and sex and which may be modified according to special 19 dietary needs or ability to chew. 20 (l) Each nursing home patient has the right to receive rep- 21 resentatives of approved organizations as provided in section 22 21763. 23 (4) A nursing home, its owner, administrator, employee, or 24 representative shall not discharge, harass, or retaliate or dis- 25 criminate against a patient because the patient has exercised a 26 right protected under this section. 04848'99 30 1 (5) In the case of a nursing home patient, the rights 2 enumerated in subsection (2)(c), (g), and (k) and subsection 3 (3)(d), (g), and (h) may be exercised by the patient's represen- 4 tative as defined in section 21703. 5 (6) A nursing home patient or home for the aged resident is 6 entitled to be fully informed, as evidenced by the patient's or 7 resident's written acknowledgment, before or at the time of 8 admission and during stay, of the policy required by this 9 section. The policy shall provide that if a NURSING HOME patient 10 or HOME FOR THE AGED resident is adjudicated incompetent and not 11 restored to legal capacity, the rights and responsibilities set 12 forth in this section shall be exercised by a person designated 13 by the NURSING HOME patient or HOME FOR THE AGED resident. The 14facility or agencyNURSING HOME OR HOME FOR THE AGED shall pro- 15 vide proper forms for the NURSING HOME patient or HOME FOR THE 16 AGED resident to provide for the designation of this person at 17 the time of admission. 18 (7) This sectionshall not be construed toDOES NOT pro- 19 hibit a health facility or agency from establishing and recogniz- 20 ing additional patients' OR RESIDENTS' rights. 21 Sec. 21515. The records, data, and knowledge INCLUDING, 22 BUT NOT LIMITED TO, MEDICAL RECORDS AS DEFINED IN SECTION 20195 23 collected for or by individuals or committees assigned a review 24 function described in this article are confidential and shall be 25 used BY THOSE INDIVIDUALS OR COMMITTEES only for the purposes 26 provided in this article,shallARE notbepublic records, 04848'99 31 1 andshallARE notbe available forSUBJECT TO court 2 subpoena. 3 Sec. 22210. (1) A hospital that applies to the department 4 for a certificate of need and meets all of the following criteria 5 shall be granted a certificate of need for a short-term nursing 6 care program with up to 10 licensed hospital beds: 7 (a) Is eligible to apply for certification as a provider of 8 swing-bed services under section 1883 of title XVIII, 9 42 U.S.C. 1395tt. 10 (b) Subject to subsection (2), has fewer than 100 licensed 11 beds not counting beds excluded under section 1883 of title XVIII 12 of the social security act. 13 (c) Does not have uncorrected licensing, certification, or 14 safety deficiencies for which the department or the state fire 15 marshal, or both, has not accepted a plan of correction. 16 (d) Provides evidence satisfactory to the department that 17 the hospital has had difficulty in placing patients in skilled 18 nursing home beds during the 12 months immediately preceding the 19 date of the application. 20 (2) After October 1, 1990, the criteria set forth in 21 subsection (1)(b) may be modified by the commission, using the 22 procedure set forth in section 22215(3). The department shall 23 not charge a fee for processing a certificate of need application 24 to initiate a short-term nursing care program. 25 (3) A hospital that is granted a certificate of need for a 26 short-term nursing care program under subsection (1) shall comply 27 with all of the following: 04848'99 32 1 (a) Not charge for or otherwise attempt to recover the cost 2 of a length of stay for a patient in the short-term nursing care 3 program that exceeds the length of time allowed for post-hospital 4 extended care under title XVIII. 5 (b) Admit patients to the short-term nursing care program 6 only pursuant to an admissions contract approved by the 7 department. 8 (c) Not discharge or transfer a patient from a licensed hos- 9 pital bed other than a hospital long-term care unit bed and admit 10 that patient to the short-term nursing care program unless the 11 discharge or transfer and admission is determined medically 12 appropriate by the attending physician. 13 (d) Permit access to a representative of an organization 14 approved under section 21764 to patients admitted to the 15 short-term nursing care program, for all of the purposes 16 described in section 21763. 17 (e) Subject to subsection (8), not allow the number of 18 patient days for the short-term nursing care program to exceed 19 the equivalent of 1,825 patient days for a single state fiscal 20 year. 21 (f) Transfer a patient in the short-term nursing care pro- 22 gram to an appropriately certified nursing home bed, county medi- 23 cal care facility bed, or hospital long-term care unit bed 24 located within a 50-mile radius of the patient's residence within 25 5 business days after the hospital has been notified, either 26 orally or in writing, that a bed has become available. 04848'99 33 1 (g) Not charge or collect from a patient admitted to the 2 short-term nursing care program, for services rendered as part of 3 the short-term nursing care program, an amount in excess of the 4 reasonable charge for the services as determined by the United 5 States secretary of health and human services under title XVIII. 6 (h) Assist a patient who has been denied coverage for serv- 7 ices received in a short-term nursing care program under title 8 XVIII to file an appeal with the medicare recovery project oper- 9 ated by the office of services to the aging. 10 (i) Operate the short-term nursing care program in accord- 11 ance with this section and the requirements of the swing bed pro- 12 visions of section 1883 of title XVIII, 42 U.S.C. 1395tt. 13 (j) Provide data to the department considered necessary by 14 the department to evaluate the short-term nursing care program. 15 The data shall include, but is not limited to, all of the 16 following: 17 (i) The total number of patients admitted to the hospital's 18 short-term nursing care program during the period specified by 19 the department. 20 (ii) The total number of short-term nursing care patient 21 days for the period specified by the department. 22 (iii) Information identifying the type of care to which 23 patients in the short-term care nursing program are released. 24 (k) As part of the hospital's policy describing the rights 25 and responsibilities of patients admitted to the hospital, as 26 required under section 20201, incorporate all of the following 04848'99 34 1 additional rights and responsibilities for patients in the 2 short-term nursing care program: 3 (i) A copy of the hospital's policy shall be provided to 4 each short-term nursing care patient upon admission, and the 5 staff of the hospital shall be trained and involved in the imple- 6 mentation of the policy. 7 (ii) Each short-term nursing care patient may associate and 8 communicate privately with persons of his or her choice. 9 Reasonable, regular visiting hours, which shall take into consid- 10 eration the special circumstances of each visitor, shall be 11 established for short-term nursing care patients to receive 12 visitors. A short-term nursing care patient may be visited by 13 the patient's attorney or by representatives of the departments 14 named in section 20156 during other than established visiting 15 hours. Reasonable privacy shall be afforded for visitation of a 16 short-term nursing care patient who shares a room with another 17 short-term nursing care patient. Each short-term nursing care 18 patient shall have reasonable access to a telephone. 19 (iii) A short-term nursing care patient is entitled to 20 retain and use personal clothing and possessions as space per- 21 mits, unless medically contraindicated, as documented by the 22 attending physician in the medical record. 23 (iv) A short-term nursing care patient is entitled to the 24 opportunity to participate in the planning of his or her medical 25 treatment. A short-term nursing care patient shall be fully 26 informed by the attending physician of the short-term nursing 27 care patient's medical condition, unless medically 04848'99 35 1 contraindicated, as documented by a physician in the medical 2 record. Each short-term nursing care patient shall be afforded 3 the opportunity to discharge himself or herself from the 4 short-term nursing care program. 5 (v) A short-term nursing care patient is entitled to be 6 fully informed either before or at the time of admission, and 7 during his or her stay, of services available in the hospital and 8 of the related charges for those services. The statement of 9 services provided by the hospital shall be in writing and shall 10 include those services required to be offered on an as needed 11 basis. 12 (vi) A patient in a short-term nursing care program ora13person authorized in writing by the patientTHE PATIENT'S AGENT 14 may, uponsubmission to the hospital of a writtenrequest, 15 inspect and copy the patient's personal RECORDS or INSPECT AND 16 COPY THE PERSON'S medical records, PURSUANT TO SECTION 20195. 17The hospital shall make the records available for inspection and18copying within a reasonable time, not exceeding 7 days, after the19receipt of the written request.AS USED IN THIS SUBPARAGRAPH, 20 "PATIENT'S AGENT" MEANS THAT TERM AS DEFINED IN SECTION 20195. 21 (vii) A short-term nursing care patient has the right to 22 have his or her parents, if the short-term nursing care patient 23 is a minor, or his or her spouse, next of kin, or patient's rep- 24 resentative, if the short-term nursing care patient is an adult, 25 stay at the facility 24 hours a day if the short-term nursing 26 care patient is considered terminally ill by the physician 27 responsible for the short-term nursing care patient's care. 04848'99 36 1 (viii) Each short-term nursing care patient shall be 2 provided with meals that meet the recommended dietary allowances 3 for that patient's age and sex and that may be modified according 4 to special dietary needs or ability to chew. 5 (ix) Each short-term nursing care patient has the right to 6 receive a representative of an organization approved under 7 section 21764, for all of the purposes described in section 8 21763. 9 (l) Achieve and maintain medicare certification under title 10 XVIII. 11 (4) A hospital or the owner, administrator, an employee, or 12 a representative of the hospital shall not discharge, harass, or 13 retaliate or discriminate against a short-term nursing care 14 patient because the short-term nursing care patient has exercised 15 a right described in subsection (3)(k). 16 (5) In the case of a short-term nursing care patient, the 17 rights described in subsection (3)(k)(iv) may be exercised by the 18 patient's representative, as defined in section 21703(2). 19 (6) A short-term nursing care patient shall be fully 20 informed, as evidenced by the short-term nursing care patient's 21 written acknowledgment, before or at the time of admission and 22 during stay, of the rights described in subsection (3)(k). The 23 written acknowledgment shall provide that if a short-term nursing 24 care patient is adjudicated incompetent and not restored to legal 25 capacity, the rights and responsibilities set forth in subsection 26 (3)(k) shall be exercised by a person designated by the 27 short-term nursing care patient. The hospital shall provide 04848'99 37 1 proper forms for the short-term nursing care patient to provide 2 for the designation of this person at the time of admission. 3 (7) Subsection (3)(k) does not prohibit a hospital from 4 establishing and recognizing additional rights for short-term 5 nursing care patients. 6 (8) Upon application, the department may grant a variation 7 from the maximum number of patient days established under subsec- 8 tion (3)(e), to an applicant hospital that demonstrates to the 9 satisfaction of the department that there is an immediate need 10 for skilled nursing beds within a 100-mile radius of the 11 hospital. A variation granted under this subsection shall be 12 valid for not more than 1 year after the date the variation is 13 granted. The department shall promulgate rules to implement this 14 subsection including, at a minimum, a definition of immediate 15 need and the procedure for applying for a variation. 16 (9) A hospital that violates subsection (3) is subject to 17 the penalty provisions of section 20165. 18 (10) A person shall not initiate a short-term nursing care 19 program without first obtaining a certificate of need under this 20 section. 21 (11) AS USED IN THIS SECTION, "TITLE XVIII" MEANS THAT TERM 22 AS DEFINED IN SECTION 20201(3)(E). 04848'99 Final page. CPD