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Medicare Enforces Ruling to Protect Hospital Patient Visitation Rights


In April 2010, President Obama issued a memorandum to the Secretary of Health and Human Services (HHS) directing the initiation of a ruling to ensure that hospitals respect the right of patients to have and designate visitors. Although that ruling was finalized by the Centers for Medicare and Medicaid Services (CMS), the guidelines have recently been updated and clarified, announced HHS Secretary Kathleen Sebelius.

CMS develops Conditions of Participation (CoPs) and Conditions for Coverage (CfCs) that health care organizations must meet in order to begin and continue participating in Medicare and Medicaid programs. These standards are the foundation for improving quality and protecting the health and safety of beneficiaries. They apply to all health care organizations, including hospitals, ambulatory surgical centers, end-stage renal disease facilities (dialysis centers), home health agencies, long-term care facilities, and hospice.

On November 17, 2010 the CoPs were updated to ensure that patients who are in a hospital setting have the right to choose their own visitors, including a visitor who is a same-sex domestic partner. Visitation privileges cannot be denied on the basis of race, color, national origin, religion, sex, sexual orientation, gender identity, or disability. Hospitals can restrict visitation in medically appropriate circumstances, however.

A hospitalized patient also has the right to designated whomever they choose to be their patient representative in the case that they are unable to make an informed decision on their own about their medical care. Patients are able to express their wishes either orally, through written consent, or through other evidence.

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This designated representative has the right to participate in the development and implementation of a plan of care, which includes being given information about the patient’s health status and being able to request or refuse treatment. The explicit designation of a representative takes precedence over any non-designated relationship and continues throughout the patient’s inpatient or outpatient stay, unless expressly withdrawn.

If a patient is incapacitated or otherwise unable to communicate these wishes upon admission, and there is no written advance directives on file, an individual who asserts that he or she is the patient’s spouse, domestic partner, parent, or other family member should be taken at his or her word without supporting documentation unless there is more than one individual claiming to represent the patient or if the hospital has reason to question the relationship.

During a CMS review of a healthcare organization, the auditor will ask to see a policy and procedure related to this CoP guideline and will review records to ensure the policies are being followed appropriately.

"Couples take a vow to be with each other in sickness and in health and it is unacceptable that, in the past, some same-sex partners were denied the right to visit their loved ones in times of need," said HHS Secretary Kathleen Sebelius. "We are releasing guidance for enforcing new rules that give all patients, including those with same-sex partners, the right to choose who can visit them in the hospital as well as enhancing existing guidance regarding the right to choose who will help make medical decisions on their behalf.”

“This announcement is another step toward equal rights for all Americans, and it is another step toward putting the patient at the center of our health care system,” said CMS Administrator Donald M. Berwick, M.D. “All patients should be afforded the same rights and privileges when they enter our health care system, and that includes the same opportunity to see their significant other.”

Source: Health and Human Services (HHS) Announcement, Sept 7,. 2011