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Hospital Visitation

State Rules

In 2008, Equality NC secured a statewide provision helping ensure that same-sex partners and other loved ones would be treated the same as immediate family. With passage of this statewide provision, North Carolina hospital patients have the right to receive the visitors who matter most to them regardless of the legal status of their relationship.

The provision - added to the Patients' Bill of Rights - states: "A patient has the right to designate visitors who shall receive the same visitation privileges as the patient’s immediate family members, regardless of whether the visitors are legally related to the patient." The right applies to hospitals statewide.

In 2007, Equality NC Foundation petitioned the state to add this provision to the Patient's Bill of Rights, and tirelessly advocated for the change through the rule-making process. The Medical Care Commission unanimously approved the rule at its February 2008 meeting and the Rules Review Commission gave final approval, allowing the rule to take effect on May 1, 2008.

CLICK HERE TO READ AND PRINT North Carolina's PATIENT BILL OF RIGHTS (includes: "(25) A patient has the right to designate visitors who shall receive the same visitation privileges as the patient's immediate family members, regardless of whether the visitors are legally related to the patient.")

IMPORTANT: Same-sex couples should be aware that this policy *only covers visitation.* In order to ensure that same-sex partners have the ability to make medical decisions in the event a partner is incapacitated, it is still vita to complete health care powers of attorney.

Without a valid health care power of attorney, decision-making authority will go to the patient's nearest legal relative, as same-sex relationships receive no recognition under North Carolina law.

Federal Rules

In 2010, the Obama Administration, through the Department of Health and Human Services (HHS), issued guidelines requiring all hospitals receiving Medicaid and Medicare funding — nearly every hospital in the country — to adopt visitation policies similar to those we have in place in North Carolina, allowing for visitation in the hospital for same sex couples on an equal footing with straight couples.

The memo quoted the hospital visitation provision of the North Carolina Hospital Patients' Bill of Rights which Equality NC proposed and got adopted by the state in 2008.

The Presidential Memorandum stated:

Many States have taken steps to try to put an end to these problems. North Carolina recently amended its Patients' Bill of Rights to give each patient "the right to designate visitors who shall receive the same visitation privileges as the patient's immediate family members, regardless of whether the visitors are legally related to the patient" — a right that applies in every hospital in the State. Delaware, Nebraska, and Minnesota have adopted similar laws.

CLICK HERE to read the full Presidential Memorandum.

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New Conditions of Participation (“CoPs”) issued by the Centers for Medicare and Medicaid Services (“CMS”) require hospitals to revise visitation policies. The CoPs are the federal health and safety standards that all Medicaid and Medicare participating hospitals and critical access hospitals (“CAHs”) must meet in order to participate in federal health care programs. The additions to the CoPs address the scope and inclusiveness of hospital visitation policies. The Joint Commission has revised its standards to conform to the new CoPs.

Below is the standard procedure issued by CMS.

COPs:

(h) Standard: Patient visitation rights. A hospital must have written policies and procedures regarding the visitation rights of patients, including those setting forth any clinically necessary or reasonable restriction or limitation that the hospital may need to place on such rights and the reasons for the clinical restriction or limitation. A hospital must meet the following requirements:

(1) Inform each patient (or support person, where appropriate) of his or her visitation rights, including any clinical restriction or limitation on such rights, when he or she is informed of his or her other rights under this section.

(2) Inform each patient (or support person, where appropriate) of the right, subject to his or her consent, to receive the visitors whom he or she designates, including, but not limited to, a spouse, a domestic partner (including a same-sex domestic partner), another family member, or a friend, and his or her right to withdraw or deny such consent at any time.

(3) Not restrict, limit, or otherwise deny visitation privileges on the basis of race, color, national origin, religion, sex, gender identity, sexual orientation, or disability.

(4) Ensure that all visitors enjoy full and equal visitation privileges consistent with patient preferences.

Guidance:

"When a patient who is not incapacitated has designated, either orally to hospital staff or in writing, another individual to be his/her representative, the hospital must involve the designated representative in the development and implementation of the patient's plan of care."

"When a patient is incapacitated or otherwise unable to communicate his or her wishes, there is no written advance directive on file or presented, and an individual asserts that he or she is the patient's spouse, domestic partner (whether or not formally established and including a same-sex domestic partner), parent (including someone who has stood in loco parentis for the patient who is a minor child) or other family member and thus is the patient's representative, the hospital is expected to accept this assertion, without demanding supporting documentation, and must involve the individual as the patient's representative in the development and implementation of the patient's plan of care."

"In such cases [when more than one individual claims to be the patient’s representative], it would be appropriate for the hospital to ask each individual for documentation supporting his/her claim to be the patient’s representative. The hospital should make its determination of who is the patient’s representative based upon the hospital’s determination of who the patient would most want to make decisions on his/her behalf. Examples of documentation a hospital might consider could include, but are not limited to, the following: proof of a legally recognized marriage, domestic partnership, or civil union; proof of a joint household; proof of shared or co-mingled finances; and any other documentation the hospital considers evidence of a special relationship that indicates familiarity with the patient’s preferences concerning medical treatment."

"Hospitals are expected to adopt policies and procedures that facilitate expeditious and non-discriminatory resolution of disputes about whether an individual is the patient's representative, given the critical role of the representative in exercising the patient's rights."

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