Your Rights as a Hospital Patient in New York State - Section 2

Glossary

Advance Directives —
Advance directives are verbal or written instructions made by you before an incapacitating illness or injury (see page 18). Advance directives communicate that your wishes about your treatment be followed if you are too sick or unable to make decisions about your care. Advance directives include but are not limited to a health care proxy, a consent to a do-not- resuscitate (DNR) order recorded in your medical record and a living will.
Cardiopulmonary Resuscitation (CPR) —
CPR is a medical procedure used to restart a patient's heart and lungs when your breathing or circulation stops (see more information).
Diagnosis Related Groups (DRGs) —
The diagnosis related group (DRG) system categorizes the entire range of reasons people are hospitalized into about 600 groups to determine how much the hospital will be paid by your insurance. The DRG system is based on the average cost of treating a patient within the same age range, diagnosed with the same or similar condition and needing the same type of treatment. For example, one amount is paid for patients with pneumonia and a different amount for patients with a broken hip. It takes into account a hospital's expenses, regional costs, inflation and patient needs. The New York State Department of Health has developed Medicaid and Workers Compensation/No Fault payments rates for each DRG within each hospital. This does not limit the number of days a patient may stay in the hospital. Your length of stay depends solely on your medical condition. (Note: Certain specialty units and facilities do not use DRGs.)
Discharge Notice —
A New York State hospital discharge notice should include information on your discharge date and how to appeal if you disagree with the notice. A discharge notice must be provided to all patients (except Medicare patients who receive a copy of an "Important Message from Medicare") in writing hours before they leave the hospital. Medicare patients must request a written discharge notice ("The Important Message from Medicare") if they disagree with discharge. If requested, the notice must be provided. Once the notice is provided and if the Medicare patient disagrees with the notice, an appeal can be processed.
Discharge Plan —
All patients (including Medicare patients) in New York State hospitals must receivee a written discharge plan before they leave the hospital. This plan should describe the arrangements for any health care services you may need after you leave the hospital. The necessary services described in this plan must be secured or reasonably available before you leave the hospital.
Discharge Planning —
Discharge planning is the process by which hospital staff work with you and your family or someone acting on your behalf to prepare and make arrangements for your care once you leave the hospital. This care may be self care, care by family members, home health assistance or admission to another health care facility. Discharge planning includes assessing and identifying what your needs will be when you leave the hospital and planning for appropriate care to meet those needs when you are discharged. A plan must Glossary be provided to you in writing before you leave the hospital. Discharge planning usually involves the patient, family members or the person you designate to act on your behalf, your doctor and a member of the hospital staff. Some hospitals have staff members who are called "discharge planners." In other hospitals, a nurse or social worker may assist in discharge planning.
Do-Not-Resuscitate (DNR) Order —
At your request, a DNR order may be included in your medical chart. It instructs the medical staff not to try to revive you if your breathing or heartbeat has stopped. This means that doctors, nurses and other health care practitioners will not initiate such emergency procedures as mouth-to-mouth resuscitation, external chest compression, electric shock, insertion of a tube to open your airway, injection of medication into your heart or open chest. Under New York State law, all adult patients can request a DNR order verbally or in writing if two witnesses are present. In addition, the Health Care Proxy Law allows you to appoint someone to make decisions about DNR and other treatments if you become unable to do so.
Health Care Proxy form —
New York State has a law that allows you to appoint someone you trust, for example, a family member or close friend as your Health Care Agent, to decide about your treatment if you lose the ability to decide for yourself. You may also use this form to indicate your wishes regarding organ donation in the event of your death (see Health Care Proxy).
Independent Professional Review Agents (IPRA) —
These review agents handle appeals for patients covered by Medicaid, private insurance or those without any insurance if they are having problems getting the care they will need after discharge from the hospital. For example, an IPRA would review the medical records of patients who are discharged before they are medically ready, and if an appropriate discharge plan has not been done or if appropriate services were not in place.
IPRO —
This is the quality improvement organization contracted by the federal and state government to review the hospital's care provided to Medicare and Medicaid patients in New York State.
  • This is the agency Medicare patients should contact if they think they are being discharged too soon from the hospital. Call toll-free at 1-888-880-9976.

    If you have complaints about the quality of care you receive as a Medicare patient, call the Medicare Hotline tollfree at 1-800-331-7767.

  • IPRO also works with the New York State Department of Health to conduct the review of hospital care provided to people who are eligible for Medicaid. This is the agency Medicaid patients should contact if they think they are being discharged too soon from the hospital. 1979 Marcus Avenue Lake Success, New York 11042

    Call toll-free at 1-800-648-4776, or 1-516-326-6131.

    Medicare and Medicaid patients may also write to IPRO at:

    • 1979 Marcus Avenue
      Lake Success, New York 11042
Living Will —
A living will is a written document that expresses in advance your specific instructions and choices about various types of medical treatments and certain medical conditions. Living wills may be recognized as evidence of your wishes (if such wishes are expressed in a clear and convincing manner)if you are seriously ill and not able to communicate.
Managed Care —
Managed care refers to the way an individual's (or family member's) health care is organized and paid for. While health maintenance organizations (HMOs) are the best known managed care plans, there are many other types. If you are enrolled in a managed care plan, your access to health care services is coordinated by the plan and/or primary care physician. Therefore, you should understand how, when and where to access health care services, including hospital services, according to your plan's rules and benefits. Read your plan's enrollment information carefully and ask questions of your plan representative to be sure you understand your benefits, rights and responsibilities.
Medicaid Title XIX of the Social Security Act) —
Medicaid is a federal program, financed by federal, state and local governments, intended to provide access to health care services for the poor, specifically those who meet certain eligibility requirements such as income level.
Medical Misconduct —
If you feel you have received poor or substandard care (incompetent, negligent or fraudulent care) from a doctor or physician assistant, you may file a report with the New York State Department of Health. Physicians and other health professionals are required by law to report any instance of suspected misconduct.
Some examples of medical misconduct are:
  • practicing the profession fraudulently, or with gross incompetence or negligence;
  • practicing while impaired by alcohol, drugs, physical disability or mental disability;
  • being convicted of a crime;
  • refusing to provide medical services because of race, creed, color or ethnic origin;
  • guaranteeing that a cure will result from medical services;
  • failing to make available to the patient or another physician, upon a patient's written request, copies of X-rays or medical records;
  • willfully making or filing a false report, or failing to file a report required by law or inducing another person to do so;
  • willfully harassing, abusing or intimidating a patient;
  • ordering excessive tests or treatment;
  • promoting the sale of services, goods, appliances or drugs in a manner that exploits the patient;
  • abandoning or neglecting a patient under and in need of immediate professional care.
Medicare (Title XVIII of the Social Security Act) —
Medicare is a federal program, administered by the federal government, which pays part of the costs of medical services for people aged 65 or older or who are disabled. Eligibility rests solely upon age or disability.
Patient Representative —
The patient representative is a member of the hospital staff who serves as a link between the patient, family, physicians and other hospital staff. The patient representative should be available to answer questions about hospital procedures, help with special needs or concerns and help solve problems. The patient representative is familiar with all hospital services and will assist you. There is no charge for services rendered by the patient representative.
Quality Improvement Organization QIO) —
QIOs are the agencies responsible for ongoing review of the inpatient hospital care provided to people who are eligible for Medicare. In New York State, the QIO is IPRO (see for definition).
Utilization Review —
Utilization review is a process where the need, appropriateness and effectiveness of care are evaluated. This is performed by a hospital utilization review (UR) committee, a Quality Improvement Organization (QIO) (see QIO), a public agency (health department, for example) or an independent organization.

Regulations and Information

This section presents each document that the law requires you receive as an inpatient in a hospital in New York State.

Information that must be provided before you leave the hospital:

  • All patients must receive a written discharge plan.
  • Medicare patients receive a copy of the "Important Message From Medicare".
  • All other patients must receive a hospital discharge notice.

If you have trouble understanding anything or have any questions about these materials, ask the hospital staff for an explanation. It is your right!

Patients' Bill of Rights

As a patient in a hospital in New York State, you have the right, consistent with law, to:

  1. Understand and use these rights. If for any reason you do not understand or you need help, the hospital MUST provide assistance, including an interpreter.
  2. Receive treatment without discrimination as to race, color, religion, sex, national origin, disability, sexual orientation, source of payment, or age.
  3. Receive considerate and respectful care in a clean and safe environment free of unnecessary restraints.
  4. Receive emergency care if you need it.
  5. Be informed of the name and position of the doctor who will be in charge of your care in the hospital.
  6. Know the names, positions and functions of any hospital staff involved in your care and refuse their treatment, examination or observation.
  7. A no smoking room.
  8. Receive complete information about your diagnosis, treatment and prognosis.
  9. Receive all the information that you need to give informed consent for any proposed procedure or treatment. This information shall include the possible risks and benefits of the procedure or treatment.
  10. Receive all the information you need to give informed consent for an order not to resuscitate. You also have the right to designate an individual to give this consent for you if you are too ill to do so. If you would like additional information, please ask for a copy of the pamphlet "Deciding About Health Care — A Guide for Patients and Families."
  11. Refuse treatment and be told what effect this may have on your health.
  12. Refuse to take part in research. In deciding whether or not to participate, you have the right to a full explanation.
  13. Privacy while in the hospital and confidentiality of all information and records regarding your care.
  14. Participate in all decisions about your treatment and discharge from the hospital. The hospital must provide you with a written discharge plan and written description of how you can appeal your discharge.
  15. Review your medical record without charge. Obtain a copy of your medical record for which the hospital can charge a reasonable fee. You cannot be denied a copy solely because you cannot afford to pay.
  16. Receive an itemized bill and explanation of all charges.
  17. Complain without fear of reprisals about the care and services you are receiving and to have the hospital respond to you and if you request it, a written response. If you are not satisfied with the hospital's response, you can complain to the New York State Health Department. The hospital must provide you with the State Health Department telephone number.
  18. Authorize those family members and other adults who will be given priority to visit consistent with your ability to receive visitors.
  19. Make known your wishes in regard to anatomical gifts. You may document your wishes in your health care proxy or on a donor card, available from the hospital.

Public Health Law(PHL)2803 (1)(g)Patient's Rights, 10NYCRR, 405.7,405.7(a)(1),405.7(c)

An Important Message Regarding Your Rights as a Hospital Inpatient

Your Rights While a Hospital Patient

You have the right to receive all of the hospital care that you need for the treatment of your illness or injury. Your discharge date is determined only by YOUR health care needs, not by your DRG category or your insurance.

You have the right to be fully informed about decisions affecting your care and your insurance coverage. ASK QUESTIONS. You have the right to designate a representative to act on your behalf.

You have the right to know about your medical condition. Talk to your doctor about your condition and your health care needs. If you have questions or concerns about hospital services, your discharge date or your discharge plan, consult your doctor or a hospital representative (such as the nurse, social worker or discharge planner).

Before you are discharged you must receive a written DISCHARGE NOTICE and a written DISCHARGE PLAN. You and/or your representative have the right to be involved in your discharge planning.

You have the right to appeal the written discharge plan or notice you receive from the hospital.

If You Think You are Being Asked to Leave the Hospital Too Soon

Be sure you have received the written notice of discharge that the hospital must give you. You need this discharge notice in order to appeal.

This notice will say whom to call and how to appeal. To avoid extra charges you must call to appeal no later than your planned discharge date. If you miss this time you may still appeal. However, you may have to pay for your continued stay in the hospital, if you lose your appeal.

Discharge Plans

In addition to the right to appeal, you have the right to receive a written discharge plan that describes the arrangements for any future health care you may need after discharge. You may not be discharged until the services required in your written discharge plan are secured or determined by the hospital to be reasonably available. You also have the right to appeal this discharge plan.

Patients' Rights*

A general statement of your additional rights as a patient must be provided to you at this time.

For Assistance/Help

The independent Professional Review Agent (IPRA) for your area and your insurance coverage is:

to be provided by hospital

*This information is now included in this booklet.
  • Patients are provided with a notice of their rights regarding admission and discharge. Medicare patients will be given the "Hospital Admission Notice for Medicare Patients", and all other patients will be given "An Important Message Regarding Your Rights as a Hospital Inpatient."
  • Public Health Law 2803 (1) (g) Discharge Review
  • 10NYCRR, 405.9 (b) (14) (i) and 405.9 (b) (14) (ii)
  • Patients (or appointed personal representatives) are provided with a written discharge notice and a copy of a discharge plan. Patients (or their representatives) must be given the opportunity to sign the documents and receive a copy of the signed documents.
  • 10NYCRR, 405.9 (g) (1) and 405.9 (g) (3) (i)

Admission Notice for Medicare Patients

You have the following rights under the New York State law:

Before you are discharged, you must receive a written Discharge Plan. You or your representative have the right to be involved in your discharge planning.

Your written Discharge Plan must describe the arrangements for any future health care that you may need after discharge. You may not be discharged until the services required in your written Discharge Plan are secured or determined to be reasonably available.

If you do not agree with the Discharge Plan or believe the services are not reasonably available, you may call the New York State Health Department to investigate your complaint and the safety of your discharge. The hospital must provide you with the State Health Department's telephone number if you ask for it.

For important information about your rights as a Medicare patient, see "Important Message from Medicare," on the following page.

Patients are provided with a notice of their rights regarding admission and discharge. Medicare patients will be given "Hospital Admission Notice for Medicare Patients", and all other patients will be given "An Important Message Regarding Your Rights as a Hospital Inpatient"
  • Public Health Law 2803 (1) (g) Discharge Review
  • 10NYCRR 405.9 (b) (14) (i) and 405.9 (b) (14) (ii)

Important Message from Medicare About Your Rights


AS A HOSPITAL INPATIENT, YOU HAVE THE RIGHT TO:

  • Receive Medicare covered services. This includes medically necessary hospital services and services you may need after you are discharged, if ordered by your doctor. You have a right to know about these services, who will pay for them, and where you can get them.
  • Be involved in any decisions about your hospital stay, and know who will pay for it.
  • Report any concerns you have about the quality of care you receive to the Quality Improvement Organization (QIO) listed here: IPRO 1-800-331-7767

YOUR MEDICARE DISCHARGE RIGHTS

Planning For Your Discharge: During your hospital stay, the hospital staff will be working with you to prepare for your safe discharge and arrange for services you may need after you leave the hospital. When you no longer need inpatient hospital care, your doctor or the hospital staff will inform you of your planned discharge date.

If you think you are being discharged too soon:

  • You can talk to the hospital staff, your doctor and your managed care plan (if you belong to one) about your concerns.
  • You also have the right to an appeal, that is, a review of your case by a Quality Improvement Organization (QIO). The QIO is an outside reviewer hired by Medicare to look at your case to decide whether you are ready to leave the hospital.
    • If you want to appeal, you must contact the QIO no later than your planned discharge date and before you leave the hospital.
    • If you do this, you will not have to pay for the services you receive during the appeal (except for charges like copays and deductibles).
  • If you do not appeal, but decide to stay in the hospital past your planned discharge date, you may have to pay for any services you receive after that date.
  • Step by step instructions for calling the QIO and filing an appeal are on page 2.

To speak with someone at the hospital about this notice, call __________________________.


Please sign and date here to show you received this notice and understand your rights.

______________________________________ _________________

Signature of Patient or Representative Date


STEPS TO APPEAL YOUR DISCHARGE

  • STEP 1: You must contact the QIO no later than your planned discharge date and before you leave the hospital. If you do this, you will not have to pay for the services you receive during the appeal (except for charges like copays and deductibles).
    • Here is the contact information for the QIO:
      • IPRO
      • 1-888-880-9976
    • You can file a request for an appeal any day of the week. Once you speak to someone or leave a message, your appeal has begun.
    • Ask the hospital if you need help contacting the QIO.
    • The name of this hospital is__{Name of Hospital}__.
  • STEP 2: You will receive a detailed notice from the hospital or your Medicare Advantage or other Medicare managed care plan (if you belong to one) that explains the reasons they think you are ready to be discharged.
  • STEP 3: The QIO will ask for your opinion. You or your representative need to be available to speak with the QIO, if requested. You or your representative may give the QIO a written statement, but you are not required to do so.
  • STEP 4: The QIO will review your medical records and other important information about your case.
  • STEP 5:The QIO will notify you of its decision within 1 day after it receives all necessary information.
    • If the QIO finds that you are not ready to be discharged, Medicare will continue to cover your hospital services.
    • If the QIO finds you are ready to be discharged, Medicare will continue to cover your services until noon of the day after the QIO notifies you of its decision.

IF YOU MISS THE DEADLINE TO APPEAL, YOU HAVE OTHER APPEAL RIGHTS:

  • You can still ask the QIO or your plan (if you belong to one) for a review of your case:
    • If you have Original Medicare: Call the QIO listed above.
    • If you belong to a Medicare Advantage Plan or other Medicare managed care plan: Call your plan.
  • If you stay in the hospital, the hospital may charge you for any services you receive after your planned discharge date.

For more information, call 1-800-MEDICARE (1-800-633-4227), or TTY: 1-877-486-2048.


Additional Information:





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