The bill allows a patient's representative to consent to an admission of an
incapacitated individual from a hospital to a nursing home or community-based
residential facility without a petition for guardianship or protective placement and
allows a patient's representative to make health care decisions and authorize
expenditures related to health care on behalf of an incapacitated individual without
certain time limitations that are imposed under current law if certain conditions are
met. Under current law, an individual who is either related to an incapacitated
individual as provided under current law or is an adult close friend of an
incapacitated individual may consent to admission, directly from a hospital to a
nursing home or community-based residential facility, of the incapacitated
individual who does not have a valid power of attorney for health care and who has
not been adjudicated incompetent in this state if certain conditions apply, including
that the individual for whom admission is sought is not diagnosed as

developmentally disabled or as having a mental illness at the time of the proposed
admission, that the incapacitated individual does not verbally object to or otherwise
actively protest the admission, and that petitions for guardianship for the individual
and for protective placement of the individual are filed prior to the proposed
admission. An individual who consents to admission of an incapacitated individual
may make health care decisions to the same extent as a guardian of the person and
authorize expenditures related to health care to the same extent as a guardian of the
estate until 60 days after the admission to the facility, discharge of the incapacitated
individual from the facility, or appointment of a guardian for the incapacitated
individual, whichever occurs first. The bill allows a patient's representative to
consent to an admission of an incapacitated individual from a hospital to a nursing
home or community-based residential facility as provided under current law
without petitions for guardianship or protective placement of the incapacitated
individual being filed if certain conditions apply, including that the patient's
representative promptly notifies all of the incapacitated individual's family
members that can be readily contacted that the patient's representative may make
decisions or authorize expenditures on the incapacitated individual's behalf, that the
patient's representative provides a written statement to the discharging hospital
that contains certain information, and that the facility to which the incapacitated
individual is admitted notifies a representative of the Board on Aging and Long Term
Care of the admission. Further, the bill allows a patient's representative to make
health care decisions and authorize expenditures related to health care without the
time limitations that apply to other direct admissions under current law if the
patient's representative satisfies the conditions for admission provided under the
bill. The authority of a patient's representative to make health care decisions and
authorize expenditures related to health care under the bill ends if a court appoints
a guardian to make such decisions.

The bill allocates 250 nursing home beds to be awarded to applicants who agree
to prioritize admissions of patients with complex needs and to prioritize admissions
of patients who have been unable to find appropriate placement at another facility.
Under current law, the maximum number of licensed nursing home beds that are
available in the state is limited in order to enable the state to budget accurately and
to allocate fiscal resources appropriately. At least once each year, the Department
of Health Services is required to publish a notice concerning the number of nursing
home beds that are available in each of its health planning areas. DHS is required
to accept applications for available nursing home beds and review the applications
based on criteria provided under current law, including cost containment, a need for
additional beds in the health planning area where the beds are requested, and
whether health care personnel, capital, and operating funds and other resources
needed to provide proposed services are available. This bill directs DHS to allocate
250 nursing home beds to be awarded to applicants as provided in the bill. An
applicant for nursing home beds allocated under the bill must apply to DHS on a form
provided DHS and include a plan for the applicant to become licensed for the nursing
home beds that the applicant requested, to become certified as a provider under the
Medical Assistance program, and to hire sufficient health care personnel and expend

sufficient resources to provide 24-hour nursing services within 18 months of DHS
approval. The bill requires that within 30 days of receipt of an application, DHS
must review applications received and approve applications that contain reasonable
plans to satisfy the above criteria within 18 months. The bill requires DHS to make
determinations on applications in the order that they are received. If DHS approves
an application, the bill requires DHS to award the beds requested in the application.
If not enough beds remain under the program to award all of the beds requested in
an application, DHS must contact the applicant and determine whether the
applicant will accept some or all of the remaining beds instead of the beds requested
in the application. If the applicant is willing to accept some or all of the remaining
beds, DHS must award those beds. DHS must continue to request and approve
applications until DHS awards all 250 nursing home beds allocated under the bill.

The bill requires DHS to select, using a competitive grant selection process,
partnership groups to be designated as participating sites for a complex patient pilot
program and then award grants to the partnership groups selected. The bill provides
that a partnership group is one or more hospitals in partnership with one or more
post-acute facilities. The bill provides that DHS must solicit feedback regarding the
pilot program from representatives of healthcare system organizations, long-term
care provider organizations, long-term care operator organizations, patient
advocate groups, insurers, and any other organization determined to be relevant by
the secretary of health services. Under the bill, DHS must require each partnership
group that applies to be designated as a site for the pilot program to address certain
issues in its application, including: 1) the number of complex patient care beds that
will be set aside in a post-acute facility or through implementation of another
innovative model of patient care in a post-acute facility to which participating
hospitals agree; 2) defined goals and measurable outcomes of the partnership both
during and after the pilot program; 3) the types of complex patients for whom care
will be provided; 4) an operating budget for the proposed site; and 5) the participant
group's expertise to successfully implement the proposal.