<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".35" citation="COMAR 10.07.01.35" title_num="10" subtitle_num="07" chapter_num="01" heading="Designation of Lay Caregivers.">
  <paragraph num="A.">
    <text>A hospital shall provide a patient or legal guardian of a patient with an opportunity to designate one lay caregiver before the discharge of the patient to their residence.</text>
  </paragraph>
  <paragraph num="B.">
    <text>The hospital’s discharge planning shall include the designation of the lay caregiver as soon as practicable in the discharge planning process.</text>
  </paragraph>
  <paragraph num="C.">
    <text>If a patient or legal guardian of a patient declines to designate a lay caregiver, the hospital shall:</text>
    <paragraph num="(1)">
      <text>Document the decision in the patient’s medical record; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Be deemed to be in compliance with this regulation.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>If a patient or legal guardian of a patient designates a lay caregiver the hospital shall record in the patient’s medical record:</text>
    <paragraph num="(1)">
      <text>The designation of the lay caregiver;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The relationship of the lay caregiver to the patient; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The name, telephone number, and address of the lay caregiver.</text>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>Release of Medical Information.</text>
    <paragraph num="(1)">
      <text>If the patient designates a lay caregiver, the hospital shall request the patient or legal guardian to consent in writing to release medical information to the lay caregiver. The release of records shall be in accordance with:</text>
      <paragraph num="(a)">
        <text>The hospital’s procedures for releasing personal health information; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>All applicable federal and State laws.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>If a patient or legal guardian of a patient declines to consent to the release of medical information to the lay caregiver, the hospital is not required to:</text>
      <paragraph num="(a)">
        <text>Provide to the lay caregiver the notice required under Health-General Article, §19-382, Annotated Code of Maryland; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Consult with the lay caregiver or provide to the lay caregiver information contained in the discharge plan issued under Health-General Article, §19-383, Annotated Code of Maryland.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="F.">
    <text>A patient or a legal guardian of the patient may change the designation of a lay caregiver in the event the lay caregiver becomes incapacitated.</text>
  </paragraph>
  <paragraph num="G.">
    <text>Regardless of the desire of the patient or legal guardian of the patient, the designated lay caregiver is not obligated to perform any aftercare for the patient.</text>
  </paragraph>
  <paragraph num="H.">
    <text>A patient or legal guardian is not required to designate a lay caregiver.</text>
  </paragraph>
  <paragraph num="I.">
    <text>Hospital Obligations.</text>
    <paragraph num="(1)">
      <text>If a patient or legal guardian of a patient designates a lay caregiver, the hospital shall notify the lay caregiver as soon as practicable of the discharge of the patient or the patient’s transfer to another hospital, licensed health care facility or other residential facility.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>As soon as practicable before the discharge of a patient, the hospital shall attempt to:</text>
      <paragraph num="(a)">
        <text>Consult with the patient’s lay caregiver to prepare the lay caregiver for the patient’s aftercare; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Issue a discharge plan that describes the aftercare needs of the patient.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>The hospital shall make reasonable attempts to consult with the lay caregiver.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>The inability of the hospital to consult with a lay caregiver may not interfere with, delay, or otherwise affect the medical care provided to the patient or the patient’s planned discharge.</text>
    </paragraph>
    <paragraph num="(5)">
      <text>The hospital shall document successful or unsuccessful attempts to contact the lay caregiver.</text>
    </paragraph>
  </paragraph>
  <paragraph num="J.">
    <text>Discharge Planning Requirements. Regardless of the request for the designation of a lay caregiver, the hospital shall comply with all discharge planning requirements in:</text>
    <paragraph num="(1)">
      <text>Regulation .27 of this chapter;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The standards imposed under the hospital’s accreditation by a State-approved accreditation organization; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>42 CFR §482.43.</text>
    </paragraph>
  </paragraph>
  <paragraph num="K.">
    <text>The designation of a lay caregiver may not:</text>
    <paragraph num="(1)">
      <text>Interfere with the rights of an agent to make health care decisions under Health-General Article, Title 5, Subtitle 6, Annotated Code of Maryland; or</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Create a private right of action against a hospital, a hospital employee, or a duly authorized agent of a hospital or otherwise supersede or replace existing rights or remedies under any other State or federal law.</text>
    </paragraph>
  </paragraph>
</regulation>