OAR 333-520-0070: Emergency Department and Emergency Services

(1) As used in this rule: (a) "Behavioral health assessment" has the meaning given that term in ORS 743A.012; (b) "Behavioral health clinician" has the meaning given that term in ORS 743A.012; (c) "Behavioral health crisis" has the meaning given that term in ORS 441.053; (d) "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; (e) "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; (f) For purposes of subsection (4)(g) of this rule, “provider” includes: (A) A behavioral health clinician as defined in section (1) of this rule; (B) A crisis counselor operating under the direction of a behavioral health clinician; (C) A qualified mental health associate as defined in OAR 309-039-0510; (D) A registered nurse whose training, experience and competence demonstrates the ability to conduct a suicidal risk assessment, provide lethal means counseling, and safety planning for suicide prevention; or (E) A 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 950, division 060. (2) Hospitals classified as general and low occupancy acute care shall have an emergency department that provides emergency services. (3) A hospital with an emergency department shall: (a) Provide emergency services 24 hours a day including providing immediate lifesaving intervention, resuscitation, and stabilization; (b) Have a licensed health care practitioner with admitting privileges on-call, 24 hours a day; (c) Have at least one registered nurse, appropriately trained to provide emergency care within the emergency service area; (d) Have adequate medical staff and other ancillary personnel necessary to provide emergency care either present in the emergency service area or available 24 hours a day in adequate numbers to respond promptly; (e) Ensure that when surgical, laboratory, and X-ray procedures are indicated and ordered, due regard is given to promptness in carrying them out; (f) Ensure that it has items for resuscitation, stabilization, and basic emergency medical care, including airway equipment and cardiac resuscitation medications and supplies for adults, children and infants; (g) Have a communication system and personnel available 24 hours a day to ensure rapid communication with ambulances and departments of the hospital including, but not limited to, X-ray, laboratory, and surgery; (h) Have a plan for emergency care based on community needs and on hospital capabilities which sets forth policies, procedures and protocols for prompt assessment, treatment and transfer of ill or injured persons, including specifying the response time permissible for medical staff and other ancillary personnel; (i) Provide for the prompt transfer of patients, as necessary, to an appropriate facility in accordance with transfer agreements, approved trauma system plans, consideration of patient choice, and consent of the receiving facility; (j) Have written transfer agreements for the care of injured or ill persons if the hospital does not provide the type of care needed; (k) Ensure that personnel are able to provide prompt and appropriate instruction to ambulance personnel regarding triage, treatment and transportation; (l) Develop, maintain, and implement current written policies and procedure that include clearly-defined roles, responsibilities, and reporting lines for emergency service personnel; (m) Maintain emergency records in accordance with OAR 333-505-0050; (n) Establish a committee of the emergency department staff who shall at least quarterly, review emergency services by evaluating the quality of emergency medical care given, and engage in ongoing development, implementation, and follow-up on corrective action plans; and (o) Ensure it provides appropriate training programs for hospital emergency service personnel. (4) 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 psychosocial 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. (A) If a registered nurse as defined in subsection (1)(f) of this rule is conducting the caring contact, the hospital shall ensure that the training, experience, and competency required to conduct the caring contact is documented in policies and procedures and that compliance is reflected in the nurse’s personnel record. (B) A hospital may facilitate caring contacts through contracts with a qualified community-based behavioral health provider, or through a suicide prevention hotline; (C) Caring contacts may be conducted in person, via telemedicine or by phone; (D) 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. (5) Policies developed in accordance with section (4) of this rule shall comply with OAR 333-505-0055 subsection (2)(a) paragraphs (B) through (D) and section (3). (6) If a hospital is also designated or categorized as a trauma hospital under ORS 431A.050 through 431A.105, the hospital shall: (a) Comply with the applicable provisions in OAR chapter 333, division 200 through 205; (b) Report trauma data to the State Trauma Registry in accordance with the requirements of the Oregon Health Authority (Authority); and (c) Fully cooperate with the approved area trauma system plan. (7) An officer or employee of a general or low occupancy acute care hospital licensed by the Authority may not deny a person an appropriate medical screening examination needed to determine whether the person is in need of emergency medical services if the screening is within the capability of the hospital, including ancillary services routinely available to the emergency department. (8) An officer or employee of any hospital licensed by the Authority may not deny services to a person diagnosed by a physician as being in need of emergency medical services because the person is unable to establish the ability to pay for the services if those emergency medical services are customarily provided at the hospital. (9) A mental or psychiatric hospital shall assess and provide initial treatment to a person that presents to the hospital with an emergency medical condition, as that term is defined in 42 CFR 489.24. The hospital shall admit the person if the emergency medical condition falls within the specialty services provided by the hospital under OAR chapter 333, division 525.