An Act To Allow a Patient To Designate a Caregiver in the Patient's Medical Record
Maine Legislature, Session 127, LD 0666
Committee Amendment CA_B_H433 (House)
Amends: 22 MRSA §1711-G

COMMITTEE AMENDMENT "/3 "to H.P. 447, L.D. 666, Bill, "An Act To Allow 
a Patient To Designate a Caregiver in the Patient's Medical Record" 
Amend the bill in section 3 in subsection 3 in paragraph E in the first line (page 1, 
line 11 in L.D.) by striking out the following: "The. caregiver" and inserting the 
following: 'The lay caregiver' 
Amend the bill in section 5 in subsection 6 in paragraph T in the first line (page 1, 
line 23 in L.D.) by striking out the following: "a caregiver" and inserting the following: '~ 
lay caregiver' 
Amend the bill by striking out all of section 6 and inserting the following: 
'Sec. 6. 22 MRSA §1711-G is enacted to read: 
§1711-G. Designated lay caregivers 
1. Definitions. As used in this section, unless the context indicates otherwise, the 
following terms have the following meanings. . .. 
. .... 
"'.,. 
A. "Aftercare" means any assistance to a patient, after the patient's discharge, that is 
directly related to the content of the patient's hospital discharge plan and that is 
provided by a lay caregiver designated pursuant to subsection 2, including assistance 
with basic or' instrumental activities of daily living, performance of medical and 
nursing tasks, assistance in administering medication and operation of medical 
equipment. 
B. 
"Discharge" means a patient's exit or release from a hospital to the patient's 
residence or another health care setting following any medical care or treatment at the 
hospital or observation at the hospital for a period that includes midnight of at least 
one calendarday.' 
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c.,. "Hospital" means a hospital that receives money und~r chapter 855 provided to 
Medicaid recipients under the provisions of the United States Social Security Act, 
Title XIX and successors to it and related rules of the department. 
' 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT" B "to H.P. 447, L.D. 666 
.12. "Residence" means a dwelling that a person considers to Qe the person's home. 
"Residence" does not include a rehabilitation facility, hospital, nursing home, assisted 
living facility, group home or any other health care facility licensed by the State. 
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2. pesignation of lay caregiver. In accordl;lnpe 'Yith ~his sup.section, C\ h~spital 
licensed under chapter 405, but not a private mental hospital as 9,escribed in. chapter 404.,. 
shall allow for the designation of a lay caregiver to provide aftercare to a patient. 
A. For a patient with capacity to make ~ealth-care decisions, as described in Title 
18-Al Article 5, Part 8, the hospital shall provide the patient wit~ at least one 
opportunity to designate a lay caregiver following the patient's admission to the 
hospital, or observation at the hospital for a period that includes midnight of at least 
one .calendar day, and prior to the patient's gisch~rge. 
........... . 
B. For ,a patient without capacity to make health-:-care decisions, as desc;ribyd in Title 
18-A, Article 5, Part 8, the hospital shall provide the patient's legal guardian, agent or 
~u~rog~te whois reasonably available ancl actillgpursuant to Title 18-:-A, Article5, 
Part 8with at least one opportunity to designate a lay caregiver following the patient's 
admission to the hospital, or observation at the hospital for a period that includes 
midnig~t of at least one calendar day, and prior t() the pati,ent's disch~rge. 
C. 
The hospital shall document the designation of a lay caregiver under this 
subsection in the patient's medical record, including the lay caregiver's name, 
relationship to the patient, telephone number, address and. any other contact 
information as provided. 
If the patient or the patient's legalgyardian, agent or 
surrogate who is reasonably available and acting pursuant to Title 18.-A, Article 5, 
Part,8 declines to designate a lay caregiver, the hospital ~h~l,l documel?-t that decision 
in the patient's medical record and that documenta~ion copstitutescompliance by the 
hospital with the requirements of this section. A designated lay caregiver may be 
removed or changed by the patient' or the patient's' legai gyarclian, agent or Sl.llTogate 
at any ti~e, sQ long ~s the change or removal is documenteq' by the hospital ill the 
pati~nt's medical record. 
D. Designation of a lay caregiver under this subsectio~ py t4ep~tient or the patient's 
leglll mardian, agent or surrogate who is reasonably av,ailable and acti~g pursuant to 
Title 18-A, Article 5, Part 8 is optional. A designated lay caregiver is not obligated 
ungerthis section toperform any aftercare tas~s for the patient. 
3.. Written consent. If a lay caregiver is designated ll:nd~r s\lbsectiol,l 2, the hospital 
shall request tha~ the patient or the patient's leglll gyardian, agent or surrogate who is 
reasonably available and acting pursuant to Title 18-A, Article 5, Part 8 provide written 
consent to release medical information regarding the ~~ope of care to the patien.t's 
de~ignated lay caregiver to carry out the purposes of this section. Writtencol1sentunder 
this sub~ection must be provided pursuant to the hospital's established procedures for 
releasing personal health information and in compliance withstate and federal law. . 
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4. 
Notice to designated lay caregiver. 
For a patient unable to effectively 
communicate with a lay caregiver designated under subsection 2, and for 'Yhom written 
consent is received under subsection 3, a hospital shall make reasonable efforts to notify 
the designated lay caregiver prior to the patient's discharge or transfer to another hospital 
licensed under chapter 405. The hospital may not withhold, delay or otherwise fail to 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT" 8" to H.P. 447, L.D. 666 
deliver medical care t() the patient or an appropriate discharge or transfer of the patient 
because the hQspital is unable to notify the designated lay caregiver in accordance with 
this subsection prior to the patient's discharge or transfer. A hospital shall docmnent in 
the patient's medical record its attempt to notify the designated lay can~giver under this 
s1;lbsection. 
5~ I?ischa~g,e plan. If written con,sent is recei,:,ed under su~c~i,on 3, a ~ospital ~hall 
make reas()nable efforts to communicate with a lay caregiver ,designated llnder suqsection 
regarging the development of a patient's discharge plan to help prepare the designated 
lay car,egiy,er for the patient's aftercare needs at the patient's residence in accordance with 
the hospital'sdischarge policy. 
6. Instruction to designated lay caregiver. If written consent is received under 
su!2section 3, prior to a patient's discharge, the hospital shall make reasQnable efforts to 
instruc;t the patient's lay caregiver designated under subsection 2, in ~ culturally 
cQmpetent manner, on how to meet the patient's a~tercare needs and shall provide a 
meaning~l QPPQrtunity for the designated lay caregiver to ask questions about the 
patiel1t's discharge plan. 
7. Noninterference with health care directives. The provisions of thts section may 
n()t be construed to interfere with the rights of an agent of a pati~nt operating under a 
valid health care directive under Title 18-A, Article 5, Part 8. 
8. Rules. The department may adopt rules t9, carrY out th,e purposes of this section, 
including defining the content and scope of any instruction given under subsection 5 or 6. 
In the development of any rules pursuant t() this subsection, the department shall consult 
with representatives of hospitals, consumers and Qrganizations that represent seniors. 
Rules adoQted pursuant to this subsection a~e routine technic;al rules pursuant to, Title 5, 
qhapter 375, subchapter 2-A.' 
SUMMARY 
This amendment, which is the minority report, makes the following changes to 
section 6 of the bill: 
1. It adds a definition of "hospital" establishing that the provisions apply only to 
hospitals that receive money under the Maine Revised Statutes, Title 22, chapter 855 
provided to Medicaid recipients under the provisions of the United States Social Security 
Act, Title XIX and successors to it and related rules of the State's Department of Health 
and Human Services; 
2. It eliminates the definition of "entry"; 
3. It eliminates the requirement that the designation of a caregiver needs to be made 
within the first 24 hours; 
4. It changes the notice requirements to caregivers from a requirement to notify to a 
requirement to make reasonable efforts to notify; 
5. It eliminates what a discharge plan must include and defers to the hospital's 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT "B" to H.P. 447, L.D. 666 
established policy; and 
6. It eliminates the instruction requirements. 
FISCAL NOTE REQUIRE!) 
(See attached) 
COMMITTEE AMENDMENT 
Approved: 06/03/15 
.;Wac 
LD666 
LR 989(03) 
An Act To Allow a Patient To Designate a Caregiver in the Patient's Medical Record 
Fiscal Note for Bill as Amended by Committee Amendment ,~( II ~ ,/531 
Committee: Health and Human Services 
') 
Fiscal Note Required: Yes 
Fiscal Note 
Minor cost increase - General Fund 
Fiscal Detail and Notes 
Any additional costs to the Department of Health and Human Services to adopt the changes in this bill are expected to 
be minor and can be absorbed within existing budgeted resources. 
LR0989(03) - Fiscal Note - Page 1 of 1