Bill
SF 2423
Defines a temporary authorized decision-maker to place non-consenting adults in appropriate care, with court oversight and protections for good-faith actions.
Jurisdiction: Iowa
Title: A bill for an act relating to care facility placement decisions for certain adults
Status: Amended into HF 2562; action history shows amendments and substitution. Fiscal note published.
Purpose and overall aim
- SF 2423 sets forth a framework for making care facility placement decisions when a patient in a care facility cannot consent to placement decisions and no authorized representative or person authorized to consent can be located after good-faith efforts.
- The bill delineates definitions, the authority to consent, duties of care facilities, court procedures for placement, and protections for participants acting in good faith.
Key provisions and changes
1) Definitions (new Chapter 144H)
- Able to consent: patient is able to understand and communicate a decision with appropriate supports.
- Authorized representative: includes a broad set of surrogate decision-makers (agent, attorney in fact, conservator, guardian, public guardian) as defined in specified Iowa code sections.
- Care facility: hospitals, medical clinics, nursing facilities, rehabilitation facilities, and residential care facilities.
- Department: Department of Health and Human Services (DHHS).
- Patient: adult receiving care services.
- Person authorized to consent: priority-based list for who may consent or withdraw consent on behalf of the patient (in order: spouse; adult children with majority agreement among available children; parents if available; adult siblings with majority agreement among available siblings).
- Placement: admission, discharge, or transfer of a patient.
- Public assistance program: Medicaid, Medicare, or a specific medical benefits package.
2) Inability to consent — certification (Sec. 144H.2)
- A physician may certify in the patient’s medical records that:
- The patient is not able to consent.
- An authorized representative has not been located after good-faith efforts.
- It is in the patient’s best interests to be discharged and placed in a physician-recommended receiving facility.
3) Authorized consent powers and duties (Sec. 144H.3)
- After certification, the person authorized to consent may:
- Make placement decisions.
- Assist with applying for health insurance or public assistance programs.
- Take actions expressly authorized by the patient.
- Duties require consideration of patient wishes/rights and the patient’s best interests.
- May access financial records and disclose health information as needed to assist with enrollment, while complying with privacy laws (HIPAA).
- Authority expires when placement is completed and enrollment decisions are resolved, or when a higher-priority representative is located.
4) Care facility duties (Sec. 144H.4)
- Social workers, discharge planners, or qualified staff must inform the authorized person of their powers and help identify a receiving facility that can provide appropriate care in the least restrictive environment.
- If a receiving facility consents, the patient shall be transferred.
5) Court order petition (Sec. 144H.5)
- After exhausting efforts to locate an authorized representative or consent holder, a care facility or attending physician may petition a court for:
- Placement of the patient in a receiving facility.
- Assistance with applying for insurance/public assistance.
- The petition must include detailed identifying information, physician certifications, and sworn affidavits from attending physicians and qualified facility staff supporting the placement, least restrictive environment, and availability of an appropriate receiving facility.
- Court grounds for granting the petition:
- Patient not able to consent.
- No authorized representative or consent holder located despite good-faith efforts.
- Receiving facility placement is in the patient’s best interest and provides appropriate care in the least restrictive setting.
- Consents to admission from the receiving facility staff.
- Court orders have time limits (up to 30 days unless completed earlier) and may authorize facility staff to apply for public programs.
- The order and related program applications remain in effect until court-imposed timelines or until the patient can consent.
6) Immunity and discipline (Sec. 144H.6)
- Good-faith actions under this chapter shield individuals and facilities from civil/criminal liability.
- Licensees acting in good faith are not subject to disciplinary action.
7) Construction (Sec. 144H.7)
- The chapter does not compel facilities to accept transfers or admissions.
- It does not repeal other laws governing transfers/admissions.
- It does not infringe patient rights under federal/state law regarding involuntary transfers/admissions.
8) Rules (Sec. 144H.8)
- DHHS may adopt rules to administer this chapter.
Impact considerations
- Targeted population: adults in care facilities who cannot consent to placement decisions and lack an available authorized representative.
- Procedure: introduces a tiered consent framework and a court-ordered pathway for placement when necessary.
- Receiving facilities: must cooperate and be capable of providing appropriate levels of care in the least restrictive environment.
- Financial: potential influence on public/private insurance enrollment and access to public assistance programs for care placement.
- Fiscal note indicates possible net revenue impact for University of Iowa Hospitals and Clinics (UIHC) due to shorter unnecessary bed days and adjustments in discharge planning, estimated at about $519,000 to $623,000 annually (revenue reduction).
Procedural and timeline aspects
- Certification process by a physician is required before empowered decision-making by the authorized consent holder.
- If no consent holder is found, a court petition can be filed; court hearings can order placement with time-bound execution (up to 30 days, depending on completion).
- Immunity provisions encourage good-faith compliance and protect involved parties from liability.
Overall, SF 2423 creates a temporary decision-maker framework for placement when patients cannot consent and no authorized representative is located, including court oversight to ensure best-interest and least-restrictive care, while protecting participants acting in good faith.
Compiled from official sources — confirm details with the bill’s official record.
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