When a bill is passed, it is “codified” as an “Oregon Revised Statute.” This is where it becomes an enforceable law of the state. House Bill 3090 (2017) is now a law – ORS 441.015 to 441.063 Related to Hospital Discharge Procedures in Chapter 272.
This Oregon statute requires hospitals with an emergency department to:
Adopt and implement policies for the release from emergency department of a patient presenting with a behavioral health crisis, including suicide prevention measures, if any, that must be taken;
At a minimum, the policies must meet the requirements in ORS 441.196 (HB2023) for hospital policies regarding the discharge of a patient who is admitted for mental health treatment; and
- Provide the Oregon Health Authority (OHA) with information about the adoption and implementation of policies.
The OHA is required to report to the interim committees of the Legislative Assembly related to health on the policies, progress on and barriers to implementing the policies and recommendations for legislative changes necessary to improve the behavioral health outcomes for individuals who are released from an emergency department following treatment for a behavioral health crisis.
Here’s what the rules say:
333-520-0070 Emergency Department and Emergency Services
Effective December 1, 2018, a hospital shall adopt, maintain and follow written policies that pertain to the release of a patient from the emergency department who is being seen for a behavioral health crisis. The policies shall include but are not limited to:
(a) A requirement to encourage the patient to designate a lay caregiver and sign an authorization form in accordance with OAR 333-505-0055(2)(b)(A);
(b) A requirement to conduct a behavioral health assessment by a behavioral health clinician;
(c) A requirement to conduct a best practices suicide risk assessment, and if indicated develop a safety plan and lethal means counseling with the patient and the designated caregiver;
(d) A requirement to assess the long-term needs of the patient which includes, but is not limited to:
(A) The patient’s need for community based services;
(B) The patient’s capacity for self-care; and
(C) To the extent practicable, whether the patient can be properly cared for in the place where the patient resided at the time the patient presented at the emergency department;
(e) A process to coordinate care through the deliberate organization of patient care activities which includes one or more of the following: notification to a patient’s primary care provider, referral to other provider including peer support as defined in OAR 333-505-0055, follow-up after release from the emergency department, or creation and transmission of a plan of care with the patient and other provider;
(f) A process for case management that includes a systematic assessment of the patient’s medical, functional and psycho-social needs and may include an inventory of resources and supports recommended by a behavioral health clinician, indicated by a behavioral health assessment, and agreed upon by the patient;
(g) A process to arrange caring contacts between a patient and a provider or follow-up services for the patient in order to successfully transition a patient to outpatient services. For purposes of this subsection “provider” includes a behavioral health clinician, peer support specialist, peer wellness specialist, family support specialist or youth support specialist as those terms are defined in ORS 414.025 and who are certified in accordance with OAR chapter 410, division 180.
(A) A hospital may facilitate caring contacts through contracts with a qualified community-based behavioral health provider, or through a suicide prevention hotline;
(B) Caring contacts may be conducted in person, via tele-medicine or by phone;
(C) Caring contacts if possible must be attempted within 48 hours of release if a behavioral health clinician has determined a patient has attempted suicide or experienced suicidal ideation; and
(h) A process to schedule a follow-up appointment with a clinician for not later than seven calendar days of release. If a follow-up appointment cannot be scheduled within seven days, the hospital must document why.
“Behavioral health assessment” has the meaning given that term in ORS 743A.012;
“Behavioral health clinician” has the meaning given that term in ORS 743A.012, which states: “Behavioral health clinician” means: (A) A licensed psychiatrist; (B) A licensed psychologist; (C) A certified nurse practitioner with a specialty in psychiatric mental health; (D) A licensed clinical social worker; (E) A licensed professional counselor or licensed marriage and family therapist; (F) A certified clinical social work associate; (G) An intern or resident who is working under a board-approved supervisory contract in a clinical mental health field; or (H) Any other clinician whose authorized scope of practice includes mental health diagnosis and treatment.
“Behavioral health crisis” has the meaning given that term in ORS 441.053, which states: “Behavioral health crisis” means a disruption in an individual’s mental or emotional stability or functioning resulting in an urgent need for immediate outpatient treatment in an emergency department or admission to a hospital to prevent a serious deterioration in the individual’s mental or physical health.
“Caring contacts” mean brief communications with a patient that starts during care transition such as discharge or release from treatment, or when a patient misses an appointment or drops out of treatment, and continues as long as a qualified mental health professional deems necessary;
“Lay caregiver” means:
(A) For a patient who is younger than 14 years of age, a parent or legal guardian of the patient;
(B) For a patient who is 14 years of age or older, an individual designated by the patient or a parent or legal guardian of the patient to the extent permitted under ORS 109.640 and 109.675; or
(C) For a patient who is 14 years or older, and who has not designated a caregiver, an individual to whom a health care provider may disclose protected health information without a signed authorization under ORS 192.567
For the full set of rules that govern Emergency Department Services, go here: Division 520