Ariz. Admin. Code § 9-10-309

Current through Register Vol. 30, No. 45, November 8, 2024

Section R9-10-309 - Discharge

A. Except as provided in R9-10-315(E) or (F), an administrator shall ensure that a discharge plan for a patient is:

1. Developed that:

a. Identifies any specific needs of the patient after discharge;

b. If the discharge date has been determined, includes the discharge date;

c. Is completed before discharge occurs; and

d. Includes a description of the level of care that may meet the patient's assessed and anticipated needs after discharge;

2. Documented in the patient's medical record within 48 hours after the discharge plan is completed; and

3. Provided to the patient or the patient's representative before the discharge occurs.

B. For a patient who was admitted after a suicide attempt or who exhibits suicidal ideation, in addition to the discharge planning requirements in subsection (A), an administrator shall ensure that:

1. The patient receives a suicide assessment; and

2. The patient or the patient's representative receives:

a. The results of the suicide assessment;

b. Information about the availability of age-appropriate, suicide crisis services, including contact information; and

c. Information about and instructions on how to access the Department of Insurance and Financial Institution's website, available through difi.az.gov, developed in compliance with A.R.S. § 20-3503(B), including how to file an appeal of an insurance determination.

C. An administrator shall ensure that:

1. A request for participation in developing a patient's discharge plan is made to the patient or the patient's representative,

2. An opportunity for participation in developing the patient's discharge plan is provided to the patient or the patient's representative, and

3. The request in subsection (C)(1) and the opportunity in subsection (C)(2) are documented in the patient's medical record.

D. An administrator shall ensure that a patient is discharged from a behavioral health inpatient facility when the patient's treatment needs are not consistent with the services that the behavioral health inpatient facility is authorized and able to provide.

E. An administrator shall ensure that there is a documented discharge order by a medical practitioner or behavioral health professional before a patient is discharged unless the patient leaves the behavioral health inpatient facility against a medical practitioner's or behavioral health professional's advice.

F. An administrator shall ensure that, at the time of discharge, a patient receives:

1. A referral for treatment or ancillary services that the patient may need after discharge, if applicable; and

2. For a patient who was admitted after a suicide attempt or who exhibits suicidal ideation, specific information about or a referral to one of the following for ongoing or follow-up treatment related to suicide, including scheduling an appointment for the patient when practicable:

a. Another health care institution;

b. A medical practitioner or, for a patient going to another state after discharge, a similarly licensed individual in the other state; or

c. A behavioral health professional certified or licensed under A.R.S. Title 32 to provide treatment related to suicide or, for a patient going to another state after discharge, a similarly certified or licensed individual in the other state.

G. If a patient is discharged to any location other than a health care institution, an administrator shall ensure that:

1. Discharge instructions are documented, and

2. The patient or the patient's representative is provided with a copy of the discharge instructions.

H. An administrator shall ensure that a discharge summary:

1. Is entered into the patient's medical record within 10 working days after a patient's discharge; and

2. Includes:

a. The following information authenticated by a medical practitioner or behavioral health professional:

i. The patient's presenting issue and other physical health and behavioral health issues identified in the patient's nursing assessment, behavioral health assessment, or treatment plan;

ii. A summary of the treatment provided to the patient;

iii. The patient's progress in meeting treatment goals, including treatment goals that were and were not achieved; and

iv. The name, dosage, and frequency of each medication ordered for the patient by a medical practitioner at the behavioral health inpatient facility at the time of the patient's discharge;

b. For a patient who was admitted after a suicide attempt or who exhibits suicidal ideation, the following information:

i. A description of the specific information about ongoing or follow-up treatment related to suicide provided to the patient or the patient's representative;

ii. Whether a referral was made for the patient according to subsection (F)(2) for ongoing or follow-up treatment related to suicide and, if so, information about the referral; and

iii. Whether an appointment was scheduled for the patient according to subsection (F)(2) for ongoing or follow-up treatment related to suicide and, if so, the date and time of the appointment; and

c. A description of the disposition of the patient's possessions, funds, or medications brought to the behavioral health inpatient facility by the patient.

I. An administrator shall ensure that a patient who is dependent upon a prescribed medication is offered detoxification services, opioid treatment, or a written referral to detoxification services or opioid treatment before the patient is discharged from the behavioral health inpatient facility if a medical practitioner for the behavioral health inpatient facility will not be prescribing the medication for the patient at or after discharge.

Ariz. Admin. Code § R9-10-309

New Section R9-10-309made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2). Amended by exempt rulemaking at 20 A.A.R. 1409, effective 7/1/2014. Amended by exempt rulemaking at 27 A.A.R. 661, effective 5/1/2021.