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ARIZONA HOUSE OF REPRESENTATIVESFifty-sixth Legislature First Regular Session |
Senate: HHS DPA 7-0-0-0 | 3rd Read 30-0-0-0
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SB 1157: hospitals; discharge planning; patient assessments
Sponsor: Senator Shope, LD 16
Caucus & COW
Overview
Instructs assisted living centers and homes (assisted living facilities) and hospitals to provide and exchange written discharge plans with each other when discharging and transferring a patient. Sets standards for hospitals and assisted living facilities discharge plans.
History
The Arizona Department of Health Services Bureau of Residential Facilities Licensing is responsible for the licensure and regulation of residential care institutions, including assisted living centers or homes amongst other facilities.
Under current law, a residential care institution means a health care institution other than a hospital or nursing care institution that provides resident beds or residential units, supervisory or personal care services, behavioral health, directed care or health-related services for persons who do not need continuous nursing services. Additionally, an assisted living center means an assisted living facility that provides resident rooms or residential units to 11 or more residents and assisted living homes means an assisted living facility that provides resident rooms to 10 or fewer residents (A.R.S. § 36-401).
Provisions
Assisted Living Facility Discharge Plans
1. Directs assisted living facilities to provide an emergency responder with a written document that contains specific resident contact and medical information if the facility contacts the emergency responder, on behalf of the resident. (Sec. 1)
2. Instructs assisted living facilities to notify the resident's authorized representative that the resident was transported to a hospital and provide the name and location of the hospital. (Sec. 1)
3. Requires assisted living facilities to maintain a standardized form for each resident that includes their personal information, except for the reason the emergency responder was requested which must be provided at the time the emergency responder is contacted. (Sec. 1)
4.
Requires assisted living facilities to
maintain a copy of the discharge documentation provided to the emergency
responder and of the facility's compliance with resident transfers for a period
of two years after the date of the emergency. (Sec. 1)
5. Specifies that if an emergency responder transports the resident to a hospital, they must provide a copy of the written discharge document to the receiving hospital. (Sec. 1)
Hospital Discharge Plans
7. Asserts that hospital discharge plans must be prepared by appropriate staff, signed and approved by a nurse practitioner, physician assistant, hospitalist or other physician. (Sec. 1)
8. Instructs the hospital discharge plans to include:
a) point-of-contact information for the discharging hospital that will be monitored and responded to 24 hours a day, 7 days a week;
b) an admission order signed and dated by a physician;
c) the current medication administration record and reconciliation form;
d) a medication order from a medical practitioner for any new medication prescribed that the patient is expected to continue; and
e) a copy of the prescription and a confirmation that the prescription was transmitted to the patient's current pharmacy. (Sec. 1)
9. Specifies that the discharge plans must also document:
a) the patient's discharge evaluation and assessment of the patient's medical or health conditions;
b) whether the assisted living facility from which the patient entered the hospital has determined that the facility cannot meet the patient's needs;
c) the hospitals assistance to the patient and their representative in selecting an appropriate provider if the patient was not a resident of a facility before entering the hospital or the facility from which the patient entered the hospital cannot meet the patients need;
d) that the hospital notified the receiving assisted living facility of the pharmacy's name and location for any new prescription drug or device orders; and
e) that the discharging hospital notified the patient's representative that the patient was discharged and provided the receiving facilities name, contact and location information. (Sec. 1)
10. Delegates a discharging hospital's designated point of contact to be available to consult with the receiving assisted living facility to assist in returning or admitting the patient to the facility and clarify any needed information in the discharge plan, before or within 48 hours after the patient is discharged in order for the facility to provide appropriate care to the patient. (Sec. 1)
11. States that if the point of contact is not a licensed medical or nurse professional and the consultation requires a qualified licensed medical or nurse professional, the discharging hospital must implement procedures to provide such consultation. (Sec. 1)
Patient Screening
12. Directs discharging hospitals to provide an opportunity for patient screenings before discharging by the assisted living facility from which the patient entered the hospital or to which the patient is being referred. (Sec. 1)
13. States that an assisted living facility must determine through a screening and a review of medical records whether the patient's post discharge care needs, including additional ordered services, are within the facility's scope of services. (Sec. 1)
14. Requires discharging hospitals to coordinate with the assisted living facilities to conduct the patient screening. (Sec. 1)
15. Forbids hospitals from discharging a patient until the patient screening is completed by the receiving facility. (Sec. 1)
16. Specifies that after receiving notification from the discharging hospital, the assisted living facility must perform the screening for patients being discharged from:
a) inpatient services within four hours; or
b) the emergency room, outpatient treatment, urgent care or observation within two hours. (Sec. 1)
17. Requires an assisted living facility from which the patient entered the hospital to readmit the patient after hospital discharge if the facility can meet the care needs for the patient. (Sec. 1)
18. Requires each hospital to develop a checklist to be used during the discharging planning process that encompasses all required discharge planning information. (Sec. 1)
19. Requires a hospital's checklist to be provided to the assisted living facility to which the patient is being discharged. (Sec. 1)
Referrals
20. Instructs discharging hospitals to provide, on request of the patient or their representative, a list of referral agencies. (Sec. 1)
21. Prohibits a discharging hospital from using a referral agency solely to fulfill the discharge planning requirements. (Sec. 1)
22. Specifies that if a referral agency or hospice agency services are used to facilitate the transfer from which the patient entered the hospital, the discharging hospital must provide the patient's former facility with the name and contact number of the referral agency or hospice agency before discharge. (Sec. 1)
Amendments
Committee on Health & Human Services
1. Requires assisted living facilities to provide an emergency responder with a written document that includes a copy of the resident's advance directives, if any, on file at the facility.
2. Instructs assisted living facilities to periodically update their residents standardized forms.
3. Directs hospitals to coordinate with the health care institution from which the patient has been transferred or the health care institution to which the patient will be discharged and provide a discharge plan for each inpatient.
4. Requires the hospital's point of contact to monitor the telephone and, if available, the email address provided and promptly respond to any inquiries 48 hours after discharge.
5. Requires hospitals to have a qualified hospital representative to respond to discharge plan questions received from the assisted living facilities.
6. Removes certain information that a hospital discharge plan must document.
7. Adds that hospital's discharge plans document includes follow-up health care services and other services recommended for the patient.
8. Specifies that copies of prescriptions must include the patient's name, medication administration instructions and the electronic signature of the prescriber and may be provided electronically.
9. Tasks discharging hospitals to contact assisted living facilities from which the patient entered the hospital, after initial inpatient assessment, to discuss an evaluation of the patient's likely post discharge health care needs.
10. Requires hospitals to reevaluate and discuss with assisted living facilities from which the patient entered the hospital the patient's condition, as appropriate, to identify changes to the patient's condition that may impact the patient's post discharge health care needs, including, if any, recommendations by the hospital to address the patient's high care needs.
11. Deletes the provision that discharging hospitals must coordinate with the assisted living facilities to conduct the patient screening and are prohibited from discharging the patient until the screening is completed by the assisted living facility.
12. Requires assisted living facilities to perform the patient screening promptly and provide documentation to the hospital demonstrating the reasons why they cannot accept the patient back to their facility if it is determined they can no longer meet the patient's needs.
13. Requires, for patients being transferred from a hospital to an assisted living facility who have not previously been admitted by the facility, discharging hospitals to coordinate with assisted living facilities to allow time to expeditiously obtain documentation from a specified health care professional coordinating the level of care needs in the facility.
14. Prescribes hospital point of contact procedures for emergency department or observation patients.
15. Removes the agency referral requirements.
16. Makes technical and conforming changes.
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20. SB 1157
21. Initials AG/BSR Page 0 Caucus & COW
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