Code of Massachusetts Regulations
105 CMR - DEPARTMENT OF PUBLIC HEALTH
Title 105 CMR 158.000 - Licensure of Adult Day Health Programs
Section 158.034 - Enrollment, Emergency Transports, and Discharges

Universal Citation: 105 MA Code of Regs 105.158

Current through Register 1531, September 27, 2024

(A) The enrollment and discharge of participants shall be in accordance with written policies and procedures developed by each Program and acceptable to the Department.

(B) A Program shall not discriminate against any participant on the basis of source of referral, source of payment, race, religion, ethnic origin, gender, sexual orientation, age, or disability. A Program shall comply with all state and federal antidiscrimination laws.

(C) A Program shall designate a member of the staff to be responsible for enrollment and discharge planning.

(D) Enrollment.

(1) A Program shall enroll and care for only those participants in need of Services and for whom it can provide care and services appropriate to the participant's physical, cognitive, psychosocial, and behavioral needs.

(2) A Program may not enroll a participant without a written order for Services from a primary care provider who determined that Program care is appropriate to meet the participant's needs.

(3) A Program may not enroll a participant without the written consent of the participant or his or her legally authorized representative, if he or she is not competent.

(4) A participant shall be screened for TB prior to enrollment in a Program. The participant's health record at the Program shall contain evidence of initial health screening for TB, including the following:
(a) A pre-enrollment TB history and risk assessment with additional screening as indicated within three months prior to enrollment in accordance with Department Bureau of Infectious Disease guidelines.

(b) An annual TB risk assessment, symptom review, and education with additional screening as indicated in accordance with Department Bureau of Infectious Disease guidelines.

(5) Participant Enrollment Agreement. A Program shall provide a written agreement to the participant and, if appropriate, to the participant's legally authorized representative. The participant enrollment agreement shall specify:
(a) The services offered to the participant by the Program and the costs of those services;

(b) The responsibilities of the participant and his or her legally authorized representative to the Program;

(c) The days and hours of Program operation;

(d) The schedule of holidays when the Program is closed;

(e) The days per week the participant will attend;

(f) Procedures for notifying the participant of any unexpected closing of the Program due to disaster or inclement weather;

(g) Arrangements for transporting the participant to and from the Program, if applicable;

(h) Emergency procedures; and

(i) Reasons the Program may initiate discharge, as specified at 105 CMR 158.034(F)(3).

(E) Emergency Transportation to an Acute Care Hospital.

(1) In the event of a medical emergency, a Program shall call the emergency access number 911 and arrange for the transport of a participant to an acute care hospital for emergency medical care.

(2) The Program shall provide all pertinent health information to the emergency medical technician(s) and to any hospital to which any participant is transported, including the participant's Comfort Care/Do Not Resuscitate Verification Form, MOLST Form, or other advance directive on file at the Program, as applicable.

(3) The Program shall contact the participant's primary care provider and legally authorized representative at the time of the emergency or immediately thereafter to advise of the emergency and all actions taken in response to the emergency.

(4) The Program shall, immediately after such medical emergency, document in the participant's health record the following:
(a) The nature of the emergency and actions taken in response to the emergency;

(b) The reason for the participant's emergency transport to an acute care hospital, if applicable; and

(c) The name of the participant's legally authorized representative who was notified of the medical emergency, and the date and time the participant's legally authorized representative was notified.

(F) Discharges.

(1) Discharge from a Program may be initiated by the Program or by the participant.

(2) A participant may choose to discontinue enrollment at a Program at any time.

(3) A Program may not discharge a participant unless one or more of the following conditions has been met:
(a) The discharge is necessary for the participant's welfare or the participant's needs can no longer be met by the Program;

(b) The participant's health has improved and he or she no longer requires Services;

(c) The safety of other participants in the Program is endangered;

(d) The health of other participants in the Program is endangered;

(e) The participant has failed, after reasonable and appropriate notice, to pay for services at the Program or to have services paid by any public or private insurer; or

(f) The Program ceases to operate.

(4) When a discharge is initiated by the Program, it shall:
(a) Arrange for the participant to be discharged to other appropriate services.

(b) Develop a discharge plan, in consultation with the participant and his or her legally authorized representative that will assist the participant in adjusting to his or her new environment and will coordinate the transition to appropriate and available services. The discharge plan shall include the provision of counseling and services to the participant in order to prepare the participant for discharge.

(c) Develop a written discharge plan that includes the following:
1. Recommendations for continuing care;

2. The setting to which the participant is to be discharged; and

3. Referrals to community services.

(d) Prepare a written discharge summary which includes a synopsis of the participant's participation in the program, his or her health status at the time of discharge, arranged services, and discharge location.

(e) Notify the local Aging Service Access Point, if applicable, 30 days prior to discharge, in cases where a participant will be referred for alternative community services.

(f) At least 30 days prior to the date of discharge, provide written notice containing sufficient explanation of reasons for discharge, discharge procedure, and discharge plan to the participant or his or her legally authorized representative and the participant's primary care provider.

(5) When the participant discontinues his or her enrollment, the Program shall be responsible for discharge service planning to facilitate a safe referral to alternate services to the extent possible.

(6) When the participant is discharged on an emergency or unplanned basis, the Program shall be responsible for discharge service planning to facilitate a safe referral to alternate services to the extent possible.

(7) A Program shall communicate with the participant or the participant's legally authorized representative at least one time within 25 business days following discharge. The Program shall document its findings regarding the participant's post-discharge status and condition in the participant's health record.

(8) A Program shall complete discharge related documentation in the participant's health record within two weeks of discharge, including documenting the reason for discharge.

Disclaimer: These regulations may not be the most recent version. Massachusetts may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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