Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 10 - DEPARTMENT OF HEALTH SERVICES - HEALTH CARE INSTITUTIONS: LICENSING › Article 10 - OUTPATIENT TREATMENT CENTERS › Section R9-10-1012 - Behavioral Health Observation/stabilization Services

Current through Register Vol. 30, No. 28, July 12, 2024
A. An administrator of an outpatient
				treatment center that is authorized to provide behavioral health observation/
				stabilization services shall ensure that:
1.
				Behavioral health observation/stabilization services are available 24 hours a
				day, every calendar day;
2.
				Behavioral health observation/stabilization services are provided in a
				designated area that:
a. Is used exclusively
				for behavioral health observation/stabilization services;
b. Has the space for a patient to receive
				privacy in treatment and care for personal needs; and
c. For every 15 observation chairs or less,
				has at least one bathroom that contains:
i. A
				working sink with running water,
ii. A working toilet that flushes and has a
				seat,
iii. Toilet tissue,
iv. Soap for hand washing,
v. Paper towels or a mechanical air hand
				dryer,
vi. Lighting, and
vii. A means of ventilation;
3. If the outpatient
				treatment center is authorized to provide behavioral health
				observation/stabilization services to individuals under 18 years of age:
a. There is a separate designated area for
				providing behavioral health observation/stabilization services to individuals
				under 18 years of age that:
i. Meets the
				requirements in subsection (B)(2), and
ii. Has floor to ceiling walls that separate
				the designated area from other areas of the outpatient treatment
				center;
b. A registered
				nurse is present in the separate designated area; and
c. A patient under 18 years of age does not
				share any space, participate in any activity or treatment, or have verbal or
				visual interaction with a patient 18 years of age or older;
4. A medical practitioner is
				available;
5. If the medical
				practitioner present at the outpatient treatment center is a registered nurse
				practitioner or a physician assistant, a physician is on-call;
6. A registered nurse is present and provides
				direction for behavioral health observation/stabilization services in the
				designated area;
7. A nurse
				monitors each patient at the intervals determined according to subsection
				(A)(12) and documents the monitoring in the patient's medical record;
8. An individual who arrives at the
				designated area for behavioral health observation/stabilization services in the
				outpatient treatment center is screened within 30 minutes after entering the
				designated area to determine whether the individual is in need of immediate
				physical health services;
9. If a
				screening indicates that an individual needs immediate physical health services
				that the outpatient treatment center is:
a.
				Able to provide according to the outpatient treatment center's scope of
				services, the individual is examined by a medical practitioner within 30
				minutes after being screened; or
b.
				Not able to provide, the individual is transferred to a health care institution
				capable of meeting the individual's immediate physical health needs;
10. If a screening indicates that
				an individual needs behavioral health observation/stabilization services and
				the outpatient treatment center has the capabilities to provide the behavioral
				health observation/stabilization services, the individual is admitted to the
				designated area for behavioral health observation/stabilization services and
				may remain in the designated area and receive observation/stabilization
				services for up to 23 hours and 59 minutes;
11. Before a patient is discharged from the
				designated area for behavioral health observation/stabilization services, a
				medical practitioner determines whether the patient will be:
a. If the behavioral health
				observation/stabilization services are provided in a health care institution
				that also provides inpatient services and is capable of meeting the patient's
				needs, admitted to the health care institution as an inpatient;
b. Transferred to another health care
				institution capable of meeting the patient's needs;
c. Provided a referral to another entity
				capable of meeting the patient's needs; or
d. Discharged and provided patient follow-up
				instructions;
12. When a
				patient is admitted to a designated area for behavioral health
				observation/stabilization services, an assessment of the patient includes the
				interval for monitoring the patient based on the patient's medical condition,
				behavior, suspected drug or alcohol abuse, and medication status to ensure the
				health and safety of the patient;
13. If a patient is not being admitted as an
				inpatient to a health care institution, before discharging the patient from a
				designated area for behavioral health observation/stabilization services, a
				personnel member:
a. Identifies the specific
				needs of the patient after discharge necessary to assist the patient to
				function independently;
b.
				Identifies any resources, including family members, community social services,
				peer support services, and Regional Behavioral Health Agency staff, that may be
				available to assist the patient; and
c. Documents the information in subsection
				(A)(13)(a) and the resources in subsection (A)(13)(b) in the patient's medical
				record;
14. When a
				patient is discharged from a designated area for behavioral health
				observation/stabilization services, a personnel member:
a. Provides the patient with discharge
				information that includes:
i. The identified
				specific needs of the patient after discharge, and
ii. Resources that may be available for the
				patient; and
b. Contacts
				any resources identified as required in subsection (A)(13)(b);
15. Except as provided in
				subsection (A)(16), a patient is not re-admitted to the outpatient treatment
				center for behavioral health observation/stabilization services within two
				hours after the patient's discharge from a designated area for behavioral
				health observation/stabilization services;
16. A patient may be re-admitted to the
				outpatient treatment center for behavioral health observation/stabilization
				services within two hours after the patient's discharge if:
a. It is at least one hour since the time of
				the patient's discharge;
b. A law
				enforcement officer or the patient's case manager accompanies the patient to
				the outpatient treatment center;
c.
				Based on a screening of the patient, it is determined that re-admission for
				behavioral health observation/stabilization is necessary for the patient;
				and
d. The name of the law
				enforcement officer or the patient's case manager and the reasons for the
				determination in subsection (A)(16)(c) are documented in the patient's medical
				record;
17. A patient
				admitted for behavioral health observation/stabilization services is provided:
a. An observation chair; or
b. A separate piece of equipment for the
				patient to use to sit or recline that:
i. Is
				at least 12 inches from the floor; and
ii. Has sufficient space around the piece of
				equipment to allow a personnel member to provide behavioral health services and
				physical health services, including emergency services, to the
				patient;
18.
				If an individual is not admitted for behavioral health
				observation/stabilization services because there is not an observation chair
				available for the individual's use, a personnel member provides support to the
				individual to access the services or resources necessary for the individual's
				health and safety, which may include:
a.
				Admitting the individual to the outpatient treatment center to provide
				behavioral health services other than behavioral health
				observation/stabilization services;
b. Establishing a method to notify the
				individual when there is an observation chair available;
c. Referring or providing transportation to
				the individual to another health care institution;
d. Assisting the individual to contact the
				individual's support system; and
e.
				If the individual is enrolled with a Regional Behavioral Health Authority,
				contacting the appropriate person to request assistance for the
				individual;
19.
				Personnel members establish a log of individuals who were not admitted because
				there was not an observation chair available and document the individual's
				name, actions taken to provide support to the individual to access the services
				or resources necessary for the individual's health and safety, and date and
				time the actions were taken;
20.
				The log required in subsection (A)(19) is maintained for at least 12 months
				after the date of documentation in the log;
21. An observation chair or, as provided in
				subsection (A)(17)(b), a piece of equipment used by a patient to sit or
				reclineis visible to a personnel member;
22. Except as provided in subsection (A)(23),
				a patient admitted to receive behavioral health observation/stabilization
				services is visible to a personnel member;
23. A patient admitted to receive behavioral
				health observation/stabilization services may use the bathroom and not be
				visible to a personnel member, if the personnel member:
a. Determines that the patient is capable of
				using the bathroom unsupervised,
b.
				Is aware of the patient's location, and
c. Is able to intervene in the patient's
				actions to ensure the patient's health and safety; and
24. An observation chair:
a. Effective until July 1, 2015, has space
				around the observation chair that allows a personnel member to provide
				behavioral health services and physical health services, including emergency
				services, to a patient in the observation chair; and
b. Effective on July 1, 2015, has at least
				three feet of clear floor space:
i. On at
				least two sides of the observation chair, and
ii. Between the observation chair and any
				other observation chair.