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ARIZONA STATE SENATE
Fifty-Sixth Legislature, First Regular Session
AMENDED
hospitals; discharge planning; patient assessments
Purpose
Effective January 1, 2024, requires assisted living centers and assisted living homes (assisted living facilities) and hospitals to provide written discharge plans to each other when discharging and transferring a patient. Outlines requirements of hospital and assisted living facility discharge plans.
Background
Residential care
institutions are health care institutions that provide resident beds or
residential units, supervisory care services, personal care services, directed
care services or
health-related services for persons who do not need inpatient nursing care (A.R.S.
§ 36-401). The Department of Health Services Bureau of Residential
Facilities Licensing licenses and regulates residential care institutions,
including assisted living facilities, secure and non-secure behavioral health
residential facilities, behavioral health respite homes, adult foster care
homes, adult day health care facilities, adult behavioral therapeutic homes and
adult residential care institutions (DHS).
An assisted living center is a residential care institution that provides or contracts to provide supervisory care, personal care services or directed care services on a continuous basis and that provides rooms to 11 or more residents, while an assisted living home provides the same services but only houses 10 or fewer residents (A.R.S. § 36-401).
There is no anticipated fiscal impact to the state General Fund associated with this legislation.
Provisions
Discharges from Assisted Living Facilities
1. Requires assisted living facilities that contact an emergency responder on behalf of a resident to provide the responder with a written document including each of the following:
a) the reason the emergency responder was requested;
b) whether the resident receives medication services and, if available, a list of the resident's prescriptions and over-the-counter medications, as well as their doses and required frequency;
c) a list of known allergies to any medications, additives, preservatives or materials like latex or adhesive;
d) the name and contact information for the resident's primary care physician and power of attorney or authorized representative;
e) basic information about the resident's physical and mental conditions and basic medical history, including diabetes or a pacemaker, frequent falls or cardiovascular and cerebrovascular events, as well as dates of recent episodes, if known;
f) the name, address and telephone number of the resident's current pharmacy;
g) point-of-contact information for the facility, including the telephone number, cell phone number, if available, and email address;
h) a copy of the resident's Health Insurance Portability and Accountability Act (HIPAA) release authorizing a receiving hospital to communicate with the assisted living facility to plan for the resident's discharge; and
i) a copy of the resident's advance directives, if any, on file at the assisted living facility.
2. Asserts that residents are not precluded from:
a) revoking their HIPAA release authorization; or
b) revoking or modifying their advance directives.
3. Requires assisted living facilities to maintain:
a) a standardized form for each resident that includes the information required in a facility discharge plan, to be updated periodically by the assisted living facility for each resident as necessary; and
b) for two years, a copy of the discharge document provided to an emergency responder, as well as documentation of the facility's compliance with resident transfer notification requirements.
4. Requires the assisted living facility point of contact to be available, 24 hours a day, 7 days a week, to respond to questions regarding provided information.
5. Requires an assisted living facility to notify a resident's authorized representative that the resident was transported to a hospital and to provide the name and location of the hospital.
6. Directs an emergency responder that transports a resident to the hospital to provide a copy of the written discharge document to the hospital.
Discharges from Hospitals
7. Requires, to protect the health and safety of patients being transferred from a hospital to an assisted living facility, a discharging hospital 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 written discharge plan for each inpatient.
8. Requires the hospital discharge plans to be prepared by appropriate staff.
9. Requires the hospital discharge plans to include:
a) point of contact information for the discharging hospital, including a telephone number and, if available, an email address;
b) if available, a copy of any prescription that was transmitted to the patient's current pharmacy or the medication summary or medication instructions, which must include the patient's name, medication administration instructions and the signature of the prescriber or a record that the prescription was electronically signed by the prescriber.
10. Requires a discharging hospital's designated point of contact to:
a) monitor the telephone and, if available, the email address provided and promptly respond to any inquiry; and
b) be available, for 48 hours after discharge, to respond to the receiving assisted living facility to assist in returning or admitting the patient to the facility as well as clarifying any needed information in the discharge plan.
11. Requires hospitals to have a qualified hospital representative respond to discharge plan questions received from the assisted living facility.
12. Requires the hospital discharge plans to document:
a) the patient's discharge evaluation and provide an assessment of the patient's medical or health conditions, including:
i. information relating to documented pressure injuries or ulcers;
ii. cognitive or physical impairments;
iii. the patient's weight bearing status;
iv. dietary requirements;
v. whether the patient requires continuous or intermittent medical or nursing services or restraints;
vi. whether the patient requires specialized medical equipment or home health services and a copy of the hospital's orders for the equipment or services; and
vii. follow-up health care services and other services recommended for the patient;
b) that the hospital notified the receiving facility of any new device orders for the patient; and
c) that the discharging hospital notified the patient's authorized representative that the patient was discharged and provided the name, location and contact information for the receiving facility.
13. Requires a discharging hospital to contact the assisted living facility from which the patient entered the hospital, after initial inpatient assessment, to discuss an evaluation of the patient's likely postdischarge health care needs.
14. Requires a discharging hospital to reevaluate and discuss, with the assisted living facility from which a patient entered the hospital, the patient's condition, as appropriate, to identify change's that may impact the patient's postdischarge health care needs, including recommendations by the hospital to transfer the patient to a different facility other than the original transferring facility to address the patient's higher care needs.
15. Requires a discharging hospital to provide an opportunity for a patient screening by the receiving assisted living facility from which the patient entered the hospital or to which the patient is being referred.
16. Requires assisted living facilities to determine, through a screening and medical records review, whether a patient's post-discharge care needs are within the facility's scope of services.
17. Requires assisted living facilities, upon notification by a discharging hospital, to perform the resident screening promptly.
18. States that, for on-site screenings, assisted living facility staff may be required to follow standard hospital security and identification requirements.
19. Requires an assisted living facility that can no longer meet the needs of a patient transferred to a hospital to provide documentation to the hospital demonstrating the reasons why the facility cannot accept the patient back.
20. Requires discharging hospitals, for patients being transferred to an assisted living facility who have not previously been admitted to the facility, to coordinate with the facility to allow time to expeditiously obtain documentation from a physician, registered nurse practitioner, registered nurse or physician assistant coordinating the level of care needed in the facility.
21. Requires discharging hospitals, for emergency department or observation patients, to provide the assisted living facility that transferred the patient with a point of contact, including a telephone number and, if available, an email address.
22. Requires an assisted living facility that transfers a resident to the hospital to readmit that resident if the facility can meet the care needs of the resident.
23. Requires hospitals to develop a discharge document that encompasses all required discharge plan information.
24. Requires a discharging hospital to provide its discharge document to the assisted living facility to which the patient is being discharged.
25. Becomes effective on January 1, 2024.
Amendments Adopted by Committee
1. Removes behavioral health residential facilities from the discharge planning requirements.
2. Requires assisted living facility discharge plans to include a copy of the resident's HIPAA release authorizing a receiving hospital to communicate with the assisted living facility to plan for the resident's discharge.
3. Requires an assisted living facility point of contact to be available, 24 hours a day, 7 days a week, to respond to questions regarding provided information.
4. Requires an assisted living facility to notify a resident's authorized representative that the resident was transported to a hospital and to provide the name and location of the hospital.
5. Removes the requirement that individual health care provider or staff phone numbers and contact information be included in an assisted living facility or hospital discharge plan, instead requiring contact information for a point of contact at the facility
6. Requires hospital discharge plans to include information about medications prescribed, rather than administered, to the patient.
7. Requires 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 as well as clarifying any needed information in the discharge plan, before or immediately after discharge, in order for the facility to provide appropriate care to the patient.
8. Removes the requirement that a hospital coordinate an assessment of a patient who is planned to be admitted for less than 12 hours.
9. Requires an assisted living facility to perform the assessment within eight hours of receiving notification from the hospital.
Amendments Adopted by Committee of the Whole
1. Requires assisted living facility discharge plans to include the name, address and telephone number of the resident's current pharmacy.
2. Removes the requirement that assisted living facility discharge plans include resident insurance information.
3. Requires assisted living facilities to maintain:
a) a standardized form for each resident that includes the information required in a facility discharge plan; and
b) for two years, a copy of the discharge document provided to an emergency responder, as well as documentation of the facility's compliance with resident transfer notification requirements.
4. Requires a discharging hospital's designated point of contact to be available to consult with a receiving assisted living facility before or within 48 hours of, rather than immediately after, the patient's discharge.
5. Removes the requirement that hospital discharge plans include an assessment of a patient's ability to provide self-care and perform activities of daily living.
6. Requires hospital discharge plans to include:
a) an assessment of the patient's weight bearing status; and
b) a copy of each of the patient's prescriptions that were ordered by the hospital, as well as confirmation that the prescriptions were transmitted to the patient's current pharmacy.
7. Requires a discharging hospital to provide an opportunity for a patient screening, rather than an assessment.
8. Removes the requirement that assisted living facilities perform hospital discharge assessments within eight hours of being notified by the hospital.
9. Requires assisted living facilities, upon notification by a discharging hospital, to perform the resident screening within four hours for patients being discharged from inpatient services and within two hours for patients being discharged from the emergency room, outpatient treatment, urgent care or observation.
10. Requires an assisted living facility that transfers a resident to the hospital to readmit that resident, upon hospital discharge, if the facility can meet the care needs of the resident.
Amendments Adopted by the House of Representatives
1. Requires assisted living facility discharge plans to include a copy of each resident's advance directives, if any, on file at the assisted living facility.
2. Asserts that residents are not precluded from:
a) revoking their HIPAA release authorization; or
b) revoking or modifying their advance directives.
3. Requires assisted living facilities to periodically update their standardized resident information form.
4. Requires discharging hospitals to coordinate with transferring or discharging health care institutions and provide a written discharge plan for each inpatient.
5. Removes the requirement that hospital discharge plans be signed and approved by a nurse practitioner, physician assistant, hospitalist or other physician.
6. Removes the requirement that hospital discharge plans include a cell phone number that will be monitored and responded to 24 hours a day, 7 days a week.
7. Requires a discharging hospital's designated point of contact to monitor the telephone and, if available, the email address provided and promptly respond to any inquiry, as well as be available to respond to the receiving assisted living facility for 48 hours.
8. Requires hospitals to have a qualified hospital representative respond to discharge plan questions received from the assisted living facility.
9. Requires hospital discharge plans to document follow-up health care services and other services recommended for the patient, rather than the level of care and services recommended for the patient.
10. Removes the requirement that hospital discharge plans document:
a) whether an assisted living facility has determined that it cannot meet a patient's needs;
b) the hospital's assistance to the patient in selecting an appropriate provider; and
c) that the hospital notified the receiving facility of any new prescription drug and the name and location of the applicable pharmacy.
11. Removes the requirement that hospital discharge plans include a signed assisted living facility admission order, the current medication administration record and medication orders for any new medication prescribed while admitted to the hospital.
12. Requires hospital discharge plans to include, if available, a copy of any prescription that was transmitted to the patient's current pharmacy or the medication summary or medication instructions.
13. Provides additional requirements of hospitals after the discharge of a patient.
14. Modifies resident discharge screening requirements.
15. Requires an assisted living facility that can no longer meet the needs of a patient transferred to a hospital to provide documentation to the hospital demonstrating the reasons why the facility cannot accept the patient back.
16. Requires discharging hospitals, for patients being transferred to an assisted living facility who have not previously been admitted to the facility, to coordinate with the facility to allow time to expeditiously obtain documentation from a physician, registered nurse practitioner, registered nurse or physician assistant coordinating the level of care needed in the facility.
17. Requires discharging hospitals, for emergency department or observation patients, to provide the assisted living facility that transferred the patient with a point of contact, including a telephone number and, if available, an email address.
18. Removes the requirement that discharging hospitals provide referral services.
Senate Action House Action
HHS 2/7/23 DPA 7-0-0 HHS 3/27/23 DPA 9-0-0-0
3rd Read 2/28/23 30-0-0 3rd Read 5/3/23 54-0-5
Prepared by Senate Research
May 3, 2023
MM/slp