(A) The Licensed or
Approved Provider shall establish written termination and discharge policies
and procedures and shall make these available to prospective patients or
residents at the time of admission. These shall include:
(1) Written criteria defining:
(a) Successful completion of
treatment;
(b) Voluntary
termination prior to program completion, except in the case of an individual
committed to treatment under M.G.L. c. 123, § 35;
(c) Involuntary termination, including:
1. emergency termination when the program
director or Practitioner reasonably determines that the patient's or resident's
continued presence in the program presents an immediate and substantial threat
of physical harm to other patients or residents, program personnel, or
property; and
2. nonemergency
termination, including notice to the patient or resident of the reasons for
termination and the right to grieve the decision as required by
105 CMR 164.080 prior
to termination; and
(d)
Procedures for determining, in consultation with the patient or resident,
referrals needed to ensure a continuum of care, reduction of risk of relapse,
and reduction of risks to patient's or resident's well-being, provided the
patient or resident is directly connected to such services prior to or within a
reasonable time following discharge. Such referrals may include, but are not
limited to:
1. certified alcohol and
drug-free housing;
2. additional
substance use disorder treatment;
3. treatment of co-occurring
disorders;
4. continued care
coordination and management with the patient's or resident's medical and
psychiatric care providers;
5.
community based overdose prevention programs;
6. employment resource;
7. community and social supports, including
family support services; and
8.
providers of medication for addiction treatment.
(2) Procedures for planning the discharge in
consultation with the patient or resident when one of the following conditions
is met and discharge will not create an immediate safety risk for the patient:
(a) Patient or resident has received optimum
benefit from treatment and further progress requires either the patient's or
resident's return to the community or the patient's or resident's referral to
another type of treatment program;
(b) Patient or resident is ready to
transition to different service type, which may be more or less intensive than
the current program;
(c) Patient or
resident voluntarily requests discharge from treatment, in which case
procedures shall include review of risks and benefits of terminating treatment;
or
(d) Patient or resident is
involuntarily terminated on a nonemergency basis.
(3) A written discharge summary, including:
(a) Description of services provided,
patient's or resident's response to such services, and progress in attaining
treatment plan goals;
(b) Patient's
or resident's substance use at discharge, including risk of overdose and
recommendations for follow-up services;
(c) Patient's or resident's current
vocational, educational and financial status;
(d) Reason for termination;
(e) Direct referrals provided;
(f) Supports and services available to the
patient or resident after discharge, provided by the Licensed or Approved
Provider or by others;
(g)
Documentation of efforts made by the Licensed or Approved Provider to prevent
discharge of a patient or resident to a shelter for the homeless;
(h) Documentation of patient's or resident's
participation in discharge planning, or of patient's or resident's refusal to
participate; and
(i) An aftercare
and follow-up plan, including method for contacting patient or resident if the
patient or resident consents to contact.
(B) The Licensed or Approved Provider shall
establish procedures for discharge if a patient or resident leaves the program
against clinical advice or is involuntarily discharged from the program
including, but not limited to, an appeal process for an involuntary discharge.
The Licensed or Approved Provider shall refer the patient or resident to
another facility/program for treatment if necessary or appropriate.
(C) Licensed or Approved Providers may
discharge patients or residents who refuse to provide information required for
necessary coordination of treatment or in an emergency situation where the
patient's or resident's continuation in the program presents an immediate and
substantial threat of physical harm to other patients or residents, program
personnel or property; provided the Licensed or Approved Provider shall
maintain documentation related to involuntary discharges, to include reasons
for involuntary discharge and referrals made, and shall make this documentation
available to the Department for inspection.
(D) Licensed or Approved Providers providing
Opioid Treatment Services shall establish additional termination and discharge
procedures as specified in
105 CMR
164.311.
(E) Licensed or Approved Providers providing
residential services, whether acute or rehabilitation, shall not develop a
discharge plan which provides for discharge of a patient or resident or patient
to a shelter for the homeless.
