Section 51 1/2: Substance use disorder evaluation and treatment for acute-care hospital or satellite emergency facility patient experiencing opioid-related overdose
Section 51 1/2. (a) For the purposes of this section, the following words shall have the following meanings:-
''Acute-care hospital'', any hospital licensed under section 51 that contains a majority of medical-surgical, pediatric, obstetric, and maternity beds, as defined by the department and the teaching hospital of the University of Massachusetts Medical School.
''Licensed mental health professional'', a: (i) licensed physician who specializes in the practice of psychiatry or addiction medicine; (ii) licensed psychologist; (iii) licensed independent clinical social worker; (iv) licensed certified social worker; (v) licensed mental health counselor; (vi) licensed psychiatric clinical nurse specialist; (vii) certified addictions registered nurse; (viii) licensed alcohol and drug counselor I as defined in section 1 of chapter 111J; or (ix) healthcare provider, as defined in section 1, qualified within the scope of the individual's license to perform substance use disorder evaluations, including an intern, resident or fellow pursuant to medical staff policies and practice.
''Satellite emergency facility'', a health care facility that operates on a 7–day per week, 24–hour per day basis that is located off the premises of a hospital, but is listed on the license of a hospital, and is authorized to accept patients transported to the facility by ambulance.
''Substance use disorder evaluation'', an evaluation ordered pursuant to subsection (b) that is conducted by a licensed mental health professional or through an emergency services program by a licensed mental health professional, which shall include, but not be limited to, the following information: (1) history of the patient's use of alcohol, tobacco and other drugs, including age of onset, duration, patterns and consequences of use; (2) the use of alcohol, tobacco and other drugs by family members; (3) types of and responses to previous treatment for substance use disorders or other psychological disorders; (4) an assessment of the patient's psychological status including co-occurring disorders, trauma history and history of compulsive behaviors; and (4) an assessment of the patient's human immunodeficiency virus, hepatitis C, and tuberculosis risk status.
(b) A person presenting in an acute-care hospital or a satellite emergency facility who is reasonably believed by the treating clinician to be experiencing an opioid-related overdose, or who has been administered naloxone prior to arriving at the hospital or facility, shall receive a substance use disorder evaluation within 24 hours of receiving emergency room services. A substance use disorder evaluation shall conclude with a diagnosis of the status and nature of the patient's substance use disorder, using standardized definitions as set forth in the Diagnostic and Statistical Manual of Mental Disorders as published by the American Psychiatric Association a diagnosis of a mental or behavioral disorder due to the use of psychoactive substances, as defined and coded by the World Health Organization. Each patient shall be presented with the findings of the evaluation in person and in writing, and the findings shall include recommendations for further treatment, if necessary, with an assessment of the appropriate level of care needed. Findings from the evaluation shall be entered into the patient's medical record. No acute-care hospital or satellite emergency facility shall permit early discharge, defined as less than 24 hours after presentation or before the conclusion of a substance use disorder evaluation, whichever occurs sooner. If a patient does not receive an evaluation within 24 hours, the treating clinician shall note in the medical record the reason the evaluation did not take place and authorize the discharge of the patient. No clinician shall be held liable in a civil suit for releasing a patient who does not wish to remain in the emergency department after stabilization, but before a substance use disorder evaluation has taken place.
(c) During or after a substance use disorder evaluation conducted pursuant to subsection (b), treatment may occur within the acute-care hospital or satellite emergency facility, if appropriate services are available, which may include induction to medication-assisted treatment. If the acute care hospital or satellite emergency facility is unable to provide such services, the acute care hospital or satellite emergency facility shall refer the patient to an appropriate and available hospital or treatment provider; provided, however, that nothing in this section shall relieve an acute care hospital or satellite emergency facility from the requirements of section 25J1/2. Medical necessity for further treatment shall be determined by the treating clinician and noted in the patient's medical record.
If a patient refuses further treatment after the evaluation is complete, and is otherwise medically stable, the acute-care hospital or satellite emergency facility may initiate discharge proceedings; provided, however, that if the patient is in need of and agrees to further treatment following discharge pursuant to the substance use disorder evaluation, then the acute care hospital or satellite emergency facility shall directly connect the patient with a community-based program prior to discharge or within a reasonable time following discharge when the community-based program is available. All patients receiving an evaluation under subsection (b) shall receive, upon discharge, information on local and statewide treatment options, providers and other relevant information as deemed appropriate by the treating clinician.
(d) If a person has received a substance use disorder evaluation within the past 3 months, further treatment and the need for a further evaluation shall be determined by the treating clinician according to best practices and procedures.
(e) If a person under 18 years of age is ordered to undergo a substance use disorder evaluation, a parent or guardian shall be notified that the minor has suffered from an opioid-related overdose and that an evaluation has been ordered. A parent or guardian may be present when the findings of the evaluation are presented to the minor.
(f) Upon discharge of a patient who experienced an opioid-related overdose, the acute-care hospital or satellite emergency facility shall notify the patient's primary care physician, if known, of the opioid-related overdose and any recommendations for further treatment.
(g) Upon discharge of a patient who experienced an opioid-related overdose, the acute-care hospital, satellite emergency facility or emergency service program shall record the opioid-related overdose and substance use disorder evaluation in the patient's electronic medical record and shall make the evaluation directly accessible by other healthcare providers and facilities consistent with federal and state privacy requirements through a secure electronic medical record, health information exchange, or other similar software or information systems to: (i) improve ease of access and utilization of such data for treatment or diagnosis; (ii) support integration of such data within the electronic health records of a healthcare provider for purposes of treatment or diagnosis; or (iii) allow healthcare providers and their vendors to maintain such data for the purposes of compiling and visualizing such data within the electronic health records of a healthcare provider that supports treatment or diagnosis.
(h) Nothing in this section shall interfere with an individual's right to refuse medical care.