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ARIZONA STATE SENATE
Fifty-Sixth Legislature, First Regular Session
AMENDED
hospitals; discharge planning; patient assessments
Purpose
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.
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) insurance information, including copies of Medicare insurance, supplement insurance and prescription drug plan card, if applicable;
g) point-of-contact information for the facility, including the telephone number, cell phone number, if available, and email address; and
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.
2. 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.
3. 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.
4. 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
5. Requires, to protect the health and safety of patients being transferred to a hospital from an assisted living facility, a discharging hospital to provide written discharge plans for patients receiving hospital services, including services provided during observation, inpatient services, outpatient services or services provided by the hospital's urgent care facility.
6. Requires the hospital discharge plans to be prepared by appropriate staff and signed and approved by a nurse practitioner, physician assistant, hospitalist or other physician.
7. Requires the hospital discharge plans to include:
a) point of contact information for the discharging hospital, including a telephone number, email address and, if available, a cell phone number, that will be monitored and responded to 24 hours a day, 7 days a week;
b) the admission order, signed and dated by a physician, to the assisted living facility;
c) the current medication administration record and reconciliation form; and
d) a medication order from a medical practitioner for any new medication prescribed while in the hospital that the patient is expected to continue after discharge.
8. 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.
9. 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 ability to perform daily living activities;
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. the level of care and services recommended for the patient.
b) whether the assisted living facility from which the patient entered the hospital has determined that it cannot meet the patient's needs;
c) the hospital's assistance to a patient and patient's representative in selecting an appropriate provider, including a list of health care institutions in the patient's desired location, if the facility from which the patient entered the hospital cannot meet the patient's needs or the patient was not a resident of the facility before entering the hospital;
d) that the hospital notified the receiving facility of the name and location of the pharmacy for any new prescription drug or device orders for the patient; and
e) 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.
10. Requires a discharging hospital to provide an opportunity for a patient assessment by the receiving assisted living facility from which the patient entered the hospital or to which the patient is being referred.
11. Requires assisted living facilities conducting a pre-discharge assessment to determine, through a screening and medical records review, whether the patient's post-discharge care needs are within the facility's scope of services.
12. Requires the discharging hospital to coordinate the assessment with the assisted living facility.
13. Prohibits a hospital from discharging a patient until an assessment is completed by the receiving assisted living facility.
14. Requires an assisted living facility to perform the assessment within eight hours of receiving notification from the hospital.
15. Requires, upon request of a patient or patient's representative, a discharging hospital to provide a list of referral agencies.
16. Prohibits a referral agency from being used by a hospital solely to fulfill discharge planning requirements.
17. Requires, prior to discharge, a hospital to provide a patient's assisted living facility with the name and contact number of any referral or hospice agency used to facilitate the transfer of the patient to a new facility or health care institution.
18. Requires hospitals to develop a checklist to be used during the discharge planning process that encompasses all required discharge plan information.
19. Requires a discharging hospital to provide its checklist to the assisted living facility in which the patient is being discharged.
20. Becomes effective on the general effective date.
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.
Senate Action
HHS 2/7/23 DPA 7-0-0
Prepared by Senate Research
February 9, 2023
MM/slp