Obama Admin. Issues New Rules Empowering Hospital Patients To Choose Visitors (Same Sex Partners...)

November 17, 2010

Washington, D.C. – Speaker Nancy Pelosi released the following statement today on the new rules issued by Secretary of Health and Human Services Kathleen Sebelius and the Centers for Medicare and Medicaid Services requiring equal visitation rights for all hospital patients, empowering them to designate their own visitors, including a same-sex domestic partner:

“Today’s announcement ensures that no one is denied the right to have the person they love by their side during a hospital stay. With these rules in place, all hospitals participating in Medicare or Medicaid must allow patients to receive visitors of their choosing and designate others to make decisions about medical care in the case of an emergency.

“For LGBT families, this change is long overdue – and it marks a critical step toward ending discrimination and upholding our nation’s promise of equality for all. I applaud President Obama for initiating this process and Secretary Sebelius for her leadership in establishing these new regulations.”

read: http://pelosi.house.gov/news/press-releases/2010/11/pelosi-statement-on-new-rules-on-equal-visitation-rights-for-all-hospital-patients.shtml


from HHS: (http://www.hhs.gov/news/press/2010pres/11/20101117a.html)

Wednesday, November 17, 2010

Medicare finalizes new rules to require equal visitation rights for all hospital patients - New requirements empower patients to designate their own visitors, including a same-sex domestic partner

The Centers for Medicare & Medicaid Services (CMS) today issued new rules for Medicare- and Medicaid-participating hospitals that protect patients’ right to choose their own visitors during a hospital stay, including a visitor who is a same-sex domestic partner.

“Basic human rights—such as your ability to choose your own support system in a time of need—must not be checked at the door of America’s hospitals,” said HHS Secretary Kathleen Sebelius. “Today’s rules help give ‘full and equal’ rights to all of us to choose whom we want by our bedside when we are sick, and override any objection by a hospital or staffer who may disagree with us for any non-clinical reason.”

The new rules follow from an April 15, 2010 Presidential Memorandum, in which President Obama tasked HHS with developing standards for Medicare- and Medicaid-participating hospitals (including critical access hospitals) that would require them to respect the right of all patients to choose who may visit them when they are an inpatient of a hospital. The President’s memorandum instructed HHS to develop rules that would prohibit hospitals from denying visitation privileges on the basis of race, color, national origin, religion, sex, sexual orientation, gender identity, or disability. It also directed that the rules take into account the need for a hospital to restrict visitation in medically appropriate circumstances.

The rules require hospitals to have written policies and procedures detailing patients’ visitation rights, as well as the circumstances under which the hospitals may restrict patient access to visitors based on reasonable clinical needs.

A key provision of the rules specifies that all visitors chosen by the patient (or his or her representative) must be able to enjoy “full and equal” visitation privileges consistent with the wishes of the patient (or his or her representative).

The rules update the Conditions of Participation (CoPs), which are the health and safety standards all Medicare- and Medicaid-participating hospitals and critical access hospitals must meet, and are applicable to all patients of those hospitals regardless of payer source.

Among other things, the rules impose new requirements on hospitals to explain to all patients their right to choose who may visit them during their inpatient stay, regardless of whether the visitor is a family member, a spouse, a domestic partner (including a same-sex domestic partner), or other type of visitor, as well as their right to withdraw such consent to visitation at any time.

“These rules put non-clinical decisions about who can visit a patient out of the hands of those who deliver care and into the hands of those who receive it,” said CMS Administrator Donald Berwick, MD, MPP. “While we still have miles to go in making care more patient-centered, these rules make it easier for hospitals to deliver on some of the fundamental tenets of patient-centered care—care that recognizes and respects the patient as an individual with unique needs, who treated with dignity and granted the power of informed choice.”

CMS finalized the rules based on thousands of comments from patient advocates, the hospital community, and other stakeholders. The rules will be effective 60 days after publication. More information about the rules is available on CMS’ website at http://www.cms.gov/CFCsAndCoPs/06_Hospitals.asp and http://www.cms.gov/CFCsAndCoPs/03_CAHs.asp.

:kick:

Not even the great and powerful Republican party could save America from the horror of sick people being visited by their loved ones in the hospital. I'm sure they tried their best, and that's all Jesus could ask from them, but it's all over now. Please look out for pieces of the sky to begin falling momentarily as The Worst Thing That Could Ever Happen has now happened. Until the next Worst Thing.

What punishment would the hospital or employees face if they have violated this rule and refused to allow an LGBTQI patient's designated visitor(s) in to the visit? "Because you aren't immediate family and we only allow immediate family to visit patients."

The rule is nice, but a rule that can't be enforced doesn't do much good.

Bigots will happily violate any rule if they can hurt us and get away with it. If they ever find that out that there is no real punishment for breaking a rule, that's basically the same as having no rule at all.

given to him to condition Medicare payment on this rule. Good for him.

Who exactly do you report this to? Is it easy to do when you're about to lose your partner due to an accident or sudden illness? Is there a simple place to register a complaint after you're denied access? What if the family disputes your partner's wishes while they're unconscious? Are their commissions set up to punish these hospitals? Is there even one federal employee to process these complaints? I'd love a link.

If he didn't oppose equality for same-sex couples, this all might be a lot clearer.

Call your Senator or congressman; raise hell; cite the rule and remind them of their obligations under federal funding . . .

You act as if you're helpless. This rule gives you something concrete to fight for.

are also going to be denying them access to the grievance process too. That seems like common sense.

If they won't let your partner in, they likely aren't going to be in a hurry to let your partner in to see the ombudsman or administrator, or take a complaint. Where do you appeal if the hospital won't listen?

These are important questions.

Call your senator or congressman? Is that really the only answer while your loved one is in the hospital? If so, then these rules are pretty toothless. :(

You are depending on the elected officials responding with more than just a form letter thanking you for your taking the time to write to them with your very important concern. You are hoping that your letter will be chosen as important enough for real attention by a live person, and get escalated up to your reps actual attention, and that your rep will choose to help all while you are still in the hospital.

I would hope that a set of RULES would have some teeth built in that a bit more definite and guaranteed than this.

The hospitals can only be reimbursed or paid by the government if they are in compliance with regulations. In Medicare, there is a stringent process of accountability. For instance, in their grievance procedure, the government agency is required to respond to a complaint within 24 hours. Hospitals are frequently and regularly monitored for compliance. The penalty for ignoring this regulation will effectively, if not explicitly, be a huge fine levied on them by HHS. The hospital administrator can effectively be reminded of that.

Yes, call your elected representative or Senator's office immediately if you have trouble. It's not uncommon and extremely likely that their office will immediately intervene to ensure compliance.

This is like any other regulation. It has to be actively and aggressively defended if it's to become standard and dependable, as I'm certain it will become in the future.

Next step if that fails would be the administration. Tell them you know Medicare's Conditions of Participation forbid them to discriminate on the basis of sexual orientation and that you will be contacting the intermediary to lodge a complaint. That should do it.

Of course, that only works if it is a Medicare facility but most are.

they discriminated against LGBTQI people is laughable. Worse, it's cruel.

Say that it really does happen. What then? A whole lot of poor people suddenly LOSE the ability to get health care at that hospital and who do they blame? Will they blame the hospital for discriminating?

No, they'll blame LBGTQI people for shutting down the hospital's ability to accept Medicare!

So this will just set up animosity between the LGBTQI community and older people and people with disabilities. The hospital will get a nice PR campaign out of it claiming that they respect everyone's rights. The LGBTQI community gets trashed. Poor people, older people, and people with disabilities suffer a loss of access to health care. Everyone losses.

It's a ridiculous standard of compliance you've set for this new regulation. Fight for your rights, damnit. The President has done what he could through his Executive office. HHS imposes fines and sanctions on providers all the time, and they get results. All that's needed to buttress this new regulation is vigilance and proaction.

I'm amazed to see folks who can produce post after post here at DU with no visible deficiency, claiming to be so helpless in defending their own rights behind this new regulation.

Besides, this regulation applies to ALL individuals, not just same-sex couples. I can recall many tragic instances where folks have been denied visitation with no recourse because they were outside of the immediate family.That will make compliance more than just a matter between hospitals and the LGBTQI community.

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So, let me get this right...

According to you we aren't really activists. We aren't really doing anything to fight for our rights. We aren't really outraged. And you know all of this... how?

Sounds to me like you're the one who just outed yourself...

sheesh.

Fight for your fights under this new regulation if you are a patient or companion to a patient. Begin with the hospital administrator. Call your Senator or representative's office if you are unable to get results. Raise hell. That's how you get compliance to this new rule.

Others will fight for their rights, as well. In time (perhaps after fines and withheld funds), it will be as routine as any other regulation.

When people are the subject of discrimination, you don't expect the subject of discrimination to bear all the weight of fighting that discrimination too. That's an invitation for failure, pain, and disaster.

If this rule is Supposed to ease the burden of discrimination, then it should at least provide a clear path and remedy for doing exactly that. And "supporters" for truly ending discrimination should do no less, and stop putting all the weight and burden of fighting discrimination back on the shoulders of the people subjected to that discrimination.

Telling the very people who have been burdened by discrimination that they need to "start fighting for your rights" as if you think they haven't been, is both disingenuous, and counterproductive. It deliberately puts all the weight of the right on the people who are supposed to be getting help from other people.

That is the very definition of "Not being an ally."

It's just common sense. This new regulation is enforced like all other regulations. Medicare dollars are at stake if hospitals don't comply. You may well need to remind hospital administrators of that. There is always an expectation that consumers may have to assert their rights under hospital regulations. This new rule gives patients leverage. It's certainly no guarantee that it will be recognized everywhere and in every situation, especially not right away, but the rule buttresses patients and their companion's rights in any dispute.

I can't help it if you think that's foolish or are anxious to paint this exchange as anything other than advice on how to get hospitals to comply. It's not as if the LGBT community are the only ones advantaged by this new regulation. It's not as if I haven't run up against visitation obstacles in my own life, of have the potential for my own family to need this new rule in some dispute with hospital administrators. I refuse to acknowledge that I intend something personal or insulting in my advice that you may well have to assert yourself to get compliance, as with ANY regulation you believe applies to you. I regret that you're offended by my responses.

As if anyone here ISN'T fighting? As if YOU would be qualified to judge whether anyone here isn't already fighting?

What an insulting statement to make!

"claiming to be so helpless?"

such ANOTHER insulting statement to make!

And yes, this is so obviously not an issue for LGBTQI people... Right, because we're obviously not the people most affected by this law. We'll take your word for that. :eyes:

If the President made a rule that doesn't include teeth then, no, he hasn't does what he could. What he has done is create a situation that sets up the LGBTQI community to be the bad guys if we use this rule. We will be seen as the new enemies of poor people, the elderly and people with disabilities when they suddenly can't get care at a hospital. If we use this rule to punish a hospital, THEY get punished. We get attacked for it. The hospital blames us for it.

Do you really think ANY hospital will sit still and take the blame that has a perfectly functional Press department they can call upon, or any left budget for Public relations? Do you really think that the policy experts in DC don't foresee the implications of this? Do you really think for even a second that they don't expect people might use this rule? And if people do use this rule, and the only outcome is the loss of care to people who depend on medicare, do you really think they don't foresee that the LGBTQI community would be the logical people to take the blame for it?

Yet here you are telling us that we need to fight for our rights, as if we're standing still and have no clue what's going on... Right... no insult intended, I'm sure. :eyes:

There's nothing at all in what I've written to deserve all of the scorn you're expressing here. At the hospital you may still need to fight for your rights, but this new regulation gives you leverage.

I really can't see how you can read what I've written and interpret the way you have. It's not an insult, it's a fact of life that we have to fight, if denied, for any law or regulation that favors us, especially an new one. That's just common sense and, I think, good advice. Sorry you're so offended by it.

when our rights are denied. That's the problem! You expect that the person who has been discriminated against should then be the one who has to do all the fighting, and should bear all the weight of that fight. You don't see any problem with that. And when we want information, and want to be prepared in advance, to make sure that fighting is UNNECESSARY, you insist that the rule is fine and dandy and tell us we just need to start fighting for our rights. Nice circle you're created.

They way I see this perspective is:

1. New rule is wonderful,
   
2. no additional information is needed,
   
3. stonewall anyone who wants to ask questions and wants to see where the limits and any built-in flaws are,
   
4. and if anything more should ever need to be done or fixed or changed because someone has been discriminated against despite this rule, let's just pile all the responsibility for this fight onto the shoulders of the person who is most vulnerable and least capable of dealing with it.
   
   (Let's also ignore that a victim of discrimination who is still a patient of the hospital who makes a big stink advocating for big changes by himself/herself may be the target of retaliation by the hosptial. Let's be so optimistic that we'll assume retaliation Never happens, especially against people who are already being discriminated against. That's a totally unrealistic fear!)
   

Oh Yes, that seems like a very productive way to address and handle any problem. :eyes:

Do you really think that approach is common sense? Really?

. . . the way you have here.

I'm a 50 year old black man. I don't need a lecture from anyone about discrimination. I've always understood that, even though we have many laws forbidding discrimination, that there will come times when, denied opportunity, access, or any other right afforded me by the law, that I may well have to assert myself to realize those rights, that access, or that opportunity. It's just ridiculous the way you've balked at that suggestion.

The rest of what you've written is your own invention and I'm not taking ANY responsibility for it.

and every protest that has ever happened exists because people don't agree with that kind of thinking.

You don't wait until something bad happens and then pile responsibility on top of the person least able to handle it. You get a group of people together and you all handle it together, and if possible you handle it in advance and make it very difficult and very uncomfortable for anyone to discriminate.

I won't get into a pissing match about who has been discriminated against more. You really don't want to try that bullshit.

... why should anyone else be bothered to do so in your behalf?

If you are discriminated against, speak up LOUDLY right then and there. Raise a stink if you have to, without your unfounded fear of retaliation by hospital staff. The doctors, nurses and technicians are professionals and I feel it's an insult to them to suggest that they would retaliate against you for pointing out the wrong/illegal actions of someone who works there. If that doesn't work, call the news stations and local papers. Shame them publicly.

Your earlier argument that people would blame the GLBT community if a hospital lost its Medicare contract is ridiculous, at best. It sounds to me like you are trying your best to defeat yourself and giving up before you even get started.

infinite ways to inflict pain on institutions not meeting CoP's. No institution will want to endure the penalties for long just so they can avoid doing the right thing.

So those are the teeth that would apply if a hospital breaks this rule?

It would be nice to know what those infinite ways are. Those are what will convince the hospital that LGBTQI patients really deserve to have our choice of visitors respected. We would like to know these things in advance.

I'm sure people understand that we've lost the point of having blind faith. We want to see the cards laid out on the table.

HHS has the 'teeth' to force these hospitals into compliance. Of course, it will take vigilance and activism to make certain hospitals are complying. But, HHS certifies these hospitals for federal dollars and determines whether they can participate or not.

Hospital Conditions of Participation
http://www.access.gpo.gov/nara/cfr/waisidx_04/42cfr482_04.html

Certification & Compliance: Hospitals
http://www.cms.gov/CertificationandComplianc/08_Hospitals.asp

Survey & Certification - Guidance To Laws & Regulations: Hospitals
http://www.cms.gov/GuidanceforLawsAndRegulations/08_Hospitals.asp

K&R for at least an attempt

I can think of other cases where friends have been denied visitation under 'immediate family-only' rules.

well this certainly helps straight unmarried couples, too

My heart aches for anyone placed in that position. Aches to tears.

I've seen it all, and this law is a step in a direction, a step only needed due to the stunning bigotry of relgious people and the heterosexual community's denial of our equal rights.

If your gay and in a relationship and enter a hospital unconscious how do you say who is going to be able to visit? Oh then we rely on the same system of directives we have now, which are often ignored or fought by family members... which does not work.

It is however a welcome step in the right direction.

"A key provision of the rules specifies that all visitors chosen by the patient (or his or her representative) must be able to enjoy “full and equal” visitation privileges consistent with the wishes of the patient (or his or her representative)."

It's not perfect, but it's a leap forward from the past.

If you don't have your paperwork in order, that usually means a family member who may or may not "approve" of the relationship. We still have to jump through the legal hoops. However, it is most definitely a step in the right direction.

at all, they will be screwed in so many ways by it.

:kick:

If you think having some kind of pocket legal paperwork saying you're "gay married" in red state America is going to help same-sex couples, you should think again. Hope it fits in your wallet. That or a lawyer.

When my partner and I get a couple grand together to talk to a lawyer about this, we'll let you know.

It empowers the patient to choose for themselves who has visitation rights.

And 'pocket-paperwork' can be invaluable. I don't know why you would discourage that. Most physicians recommend that.

Like ANY law or regulation, this may well take time for institutions to become accustomed to complying, but after enough noise and insistence (and maybe a few HHS fines), it will become old hat.

(there is a data base on the net and you can file copies with local health care providers a/ hospitals and make sure the person you choose knows about it and where it is.
Im sorry I don't know the rules in evey state, but in NYC we did this with a doctor, not a lawyer. I hope that helps.
I do think having this kind of fthing is pretty much the only thing gay couples- as well as single people- can currently do to have their wishes followed ithout a parent or estranges sibling interfering. Hence the suggestion. I was just trying to be helpful, it seems many here- includng you- were unaware that this is an option in some states. I'm not in an way sugggesting it as a substitute for marriage, just as you are probably not suggesting that all straight people are married or want their legal next of kin to be the decider.

There are two things you can do right now: 1) a hospital visitation authorization form, and 2) a health care directive or durable power of attorney for health care.

• Hospital visitation authorization: This form tells the hospital that you want a particular person to be able to visit you. If you end up in a hospital, you want to be sure that you can see the people you love—whether that is your partner, a close friend, or chosen family member.

• Health care directive or durable power of attorney for health care: This form lets you say who you want to make decisions for you if you can’t. Even if you are married or in a registered domestic partnership or civil union, your relationship may not be respected without this form. Also, with this form you can choose someone other than your spouse or partner to make medical decisions for you, if you wish.

For more information on other ways to protect your family, please take a look at NCLR’s publication Lifelines: (http://www.nclrights.org/site/DocServer/NCLR_LIFELINES.pdf?docID=521) (pdf)

download this FAQ (http://www.nclrights.org/site/DocServer/Equal_Hospital_Visitation_Rights_FAQ.pdf?docID=7921) (pdf)

As well as a living will in legal documents that they carry copies of with them. If someone is named your health care advocate, they must be allowed to see you to check on and to direct your care. Of course, under the old rules, that did not stop a Florida hospital from preventing the SO of a gay person from visiting or from making the health care decisions for them as required by law. But that hospital is being sued for denying the patient's chosen advocate access. (Sorry, I do not have the links to that story - I read about it in a post here and links in that post.)

be prepared and proactive

Thank you.

but is still opposed to allowing racially mixed marriages.

Progress, I suppose, but he's not quite there yet, is he?

. . . still, this rule will cover many more instances than just ensuring the visitation rights of same-sex couples.

:kick:

still, if this was bad news there would be four or five threads attacking Obama on it. Good news seems to be mostly drawing naysayers who claim it is not really good.

:toast:

from The Advocate: http://www.advocate.com/News/Daily_News/2010/11/17/New_Hospital_Visitation_Rule_Issued/

Hospitals will be required to have written policies and procedures detailing visitation rights and the specific circumstances under which a hospital can restrict access based on reasonable clinical needs. Hospitals must also inform incoming patients of their right to choose their visitors, regardless of whether the visitor is a family member, a spouse, a domestic partner (including a same-sex domestic partner), or other type of visitor, as well as their right to withdraw such consent to visitation at any time.

Ken Choe, deputy general counsel at HHS, said no documentation will be required to prove any particular kind of relationship. Patients need only give an oral designation of whom they wish to permit access to, a designation that can also be revoked at any point during their stay.

If a patient enters the hospital unconscious, Choe said complications with access would only arise if two people claimed to be the person who should be making visitation decisions on the patient’s behalf. In that case, hospitals would be allowed to ask for documentation in order to determine who should be allowed access to the patient.

Choe said complaints can be lodged against hospitals believed to be out of compliance in several ways. All hospitals must have a formalized internal grievance process, and people can also report hospitals to their state’s Survey and Certification Process, which governs Medicare and Medicaid participation. Medicare beneficiaries can also take their concerns to Quality Improvement Organizations (QIOs) in every state.

read: http://www.advocate.com/News/Daily_News/2010/11/17/New_Hospital_Visitation_Rule_Issued/


from the HHS directive (Final Rule): (http://bit.ly/9MPdV6)

Comment: A few commenters approved of the proposed
regulation, and suggested that fines, civil penalties, and/or
jail time should be imposed upon hospitals and individuals
that deny loved ones access to patients on an impermissible
basis. Others suggested that a list of non-compliant
facilities should be made available to the public.

Response: As a CoP for hospitals and CAHs, noncompliance
with this provision could result in the provider’s terminationഊCMS-3228-F 13 from the Medicare program. Medicare is the single largest
health care payer in the country; therefore, being terminated
from participation in the Medicare program, and therefore
unable to receive Medicare payments, is a very serious
consequence that all participating hospitals endeavor to
avoid. Hospitals and CAHs that have been terminated from
Medicare participation may also not receive Medicaid payments.
Therefore, we believe that hospitals and CAHs already have a
very strong incentive, absent fines and other consequences, to
comply with this requirement. In addition, CMS does not have
the legal authority to impose other types of sanctions for
non-compliant hospitals or CAHs outside of the existing
scheme. Because, at this time, no quality measures have been
developed relating to compliance with this requirement, CMS is
not in a position to publicly report this data. However,
should a quality measure be developed in the future, this
information could be included on the Hospital Compare website
(http://www.hospitalcompare.hhs.gov/).

... and yet sad that this is still going on in the America of the XXI century.

...who they *don't* want to allow in to visit them. Just because someone is a "blood relative," for instance, doesn't necessarily mean I'd want them to visit me in the hospital. Stress is detrimental to recovery, after all.

___ Among other things, the rules impose new requirements on hospitals to explain to all patients their right to choose who may visit them during their inpatient stay, regardless of whether the visitor is a family member, a spouse, a domestic partner (including a same-sex domestic partner), or other type of visitor, as well as their right to withdraw such consent to visitation at any time.

Great news.

Electing democrats matters.

People should be able to have anyone they want visit them in the hospital, whether they are connected by blood, romantic partnership, or none of the above. I have two best friends who are like sisters to me, and if I was in the hospital, I'd want them to be able to be there.