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HOUSE OF REPRESENTATIVES - FLOOR VERSION
STATE OF OKLAHOMA
1st Session of the 58th Legislature (2021)
HOUSE BILL 1877 By: West (Tammy) of the House
and
Coleman of the Senate
AS INTRODUCED
An Act relating to assisted living centers; amendi ng
Section 1, Chapter 311, O.S.L. 2019 (63 O.S. Supp.
2020, Section 1-881), which relates to prescribing
antipsychotic drugs to long -term care facility
residents; modifying definition; amending 63 O.S.
2011, Section 1-890.8, as amended by Section 1,
Chapter 248, O.S.L. 2013 (63 O.S. Supp. 2020, Section
1-890.8) which relates to the plan of accommodation
for certain disabled residents; modifying criteria
for prescription of antipsychotic drugs for
residents; requiring assessments and monitoring;
listing requirements; requiring documentation; and
providing an effective date .
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. AMENDATORY Section 1, Chapter 311, O.S.L.
2019 (63 O.S. Supp. 2020, Section 1 -881), is amended to read as
follows:
Section 1-881. A. As used in this section:
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1. "Antipsychotic drug" means a drug, sometimes called a major
tranquilizer, used to treat symptoms of severe psychiatric
disorders, including , but not limited to, schizophrenia and bipol ar
disorder;
2. "Long-term care facility" means:
a. a nursing facility as defined by Section 1 -1902 of
Title 63 of the Oklahoma Statutes this title,
b. the nursing facility component of a continuum of care
facility as defined under the Continuum of Care a nd
Assisted Living Act, or
c. the nursing care component of a life care community as
defined by the Long-term Care Insurance Act;
3. "Resident" means a resident as defined by Section 1 -1902 of
Title 63 of the Oklahoma Statutes this title;
4. "Representative of a resident" means a representative of a
resident as defined by Section 1 -1902 of Title 63 of the Oklahoma
Statutes this title; and
5. "Prescribing clinician " means:
a. an allopathic or osteopathic physician licensed by and
in good standing with the State Board of Medical
Licensure and Supervision or the State Board of
Osteopathic Examiners, as appropriate,
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b. a physician assistant licensed by and in good standing
with the State Board of Medical Licensure and
Supervision, or
c. an Advanced Practice R egistered Nurse licensed by and
in good standing with the Oklahoma Board of Nursing.
B. Except in case of an emergency in which the resident poses
harm to the resident or others, no long -term care facility resident
shall be prescribed or administered an a ntipsychotic drug that was
not already prescribed to the resident prior to admission to the
facility unless each of the following conditions has been satisfied:
1. The resident has been examined by the prescribing clinician
and diagnosed with a psychiatri c condition and the prescribed drug
is approved by the United States Food and Drug Administration for
that condition or prescribed in accordance with generally accepted
clinical practices;
2. The prescribing clinician, or a previous prescribing
clinician, has unsuccessfully attempted to accomplish the drug 's
intended effect using contemporary and generally accepted
nonpharmacological care options, and has documented those attempts
and their results in the resident 's medical record or has deemed
that those attempts would not be medically appropriate based upon a
physical examination by the prescribing clinician and documented the
rationale in the resident 's medical record;
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3. The facility has provided to the resident or representative
of a the resident a written explanation of applicable informed
consent laws. The explanation shall be written in language that the
resident or representative of a resident can be reasonably expected
to understand;
4. The prescribing clinician has confirmed with the nursing
facility verbally or otherwise that written, informed consent has
been obtained from the resident or representative of the resident
that meets the requirements of subsection C of this section; and
5. In the event a long -term care facility resident is
prescribed an antipsychotic medication in the case of an emergency,
the prescribing physician shall prescribe the minimum dosage and
duration that is prudent for the resident 's condition and shall
examine the patient in person within thirty (30) days.
C. Except in the case of an emergency as provided for in
subsection B of this section, the prescribing clinician shall
confirm that written, voluntary informed consent to authorize the
administration of an antipsychotic drug to a facility resident has
been obtained from the resident or the representative of the
resident prior to the initial administration of the antipsychotic
drug. Voluntary informed consent shall, at minimum, consist of the
following:
1. The prescribing clinician has confirmed that a signed,
written affirmation has been obtained from the resident or the
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representative of the resident that the resident has been informed
of all pertinent information concerning the administration of an
antipsychotic drug in language that the signer can reasonably be
expected to understand. Pertinent information shall include, but
not be limited to:
a. the reason for the drug 's prescription and the
intended effect of the drug on the resident 's
condition,
b. the nature of the drug and the procedure for its
administration, including dosage, administration
schedule, method of delivery and expected duration for
the drug to be administered,
c. risks, common side effects and potential severe
adverse reactions associated with the administration
of the drug,
d. the right of the resident or representative of the
resident to refuse the administration of the
antipsychotic drug and the medical consequences of
such refusal, and
e. an explanation of pharmacological and
nonpharmacological alternatives to the administration
of antipsychotic drugs and the resident 's right to
choose such alternatives; and
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2. Except in the case of an emergency as provided for in
subsection B of this section, the prescribing clinician shall inform
the resident or the representative of the resident of the e xistence
of the long-term care facility's policies and procedures for
compliance with informed consent requirements. The facility shall
make these available to the resident or representative of the
resident prior to administering any antipsychotic drug up on request.
D. 1. Antipsychotic drug prescriptions and administration
shall be consistent with standards for dosage, duration and
frequency of administration that are generally accepted for the
resident's condition.
2. Throughout the duration of the adm inistration of an
antipsychotic drug and at generally accepted intervals approved for
the resident's condition, the prescribing clinician or designee
shall monitor the resident 's condition and evaluate drug performance
with respect to the condition for whi ch the drug was prescribed.
The prescribing clinician shall provide documentation of the status
of the resident's condition to the resident or the representative of
the resident upon request and without unreasonable delay.
3. Any change in dosage or dura tion of the administration of an
antipsychotic drug shall be justified by the prescribing clinician
with documentation on the resident 's record of the clinical
observations that warranted the change.
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E. 1. No long-term care facility shall deny admission or
continued residency to a person on the basis of the person 's or his
or her representative 's refusal to the administration of
antipsychotic drugs, unless the prescribing clinician or care
facility can demonstrate that the resident 's refusal would place t he
health and safety of the resident, the facility staff, other
residents or visitors at risk.
2. Any care facility that alleges that the resident 's refusal
to consent to the administration of antipsychotic drugs will place
the health and safety of the re sident, the facility staff, other
residents or visitors at risk shall document the alleged risk in
detail and shall present this documentation to the resident or the
representative of the resident, to the State Department of Health
and to the Long-Term Care Ombudsman;, and shall inform the resident
or the representative of the resident of the resident 's right to
appeal to the State Department of Health. The documentation of the
alleged risk shall include a description of all nonpharmacological
or alternative care options attempted and why they were unsuccessful
or why the prescribing clinician determined alternative treatments
were not medically appropriate for the condition following a
physical examination.
F. The provisions of this section shall not appl y to a hospice
patient as defined in Section 1 -860.2 of Title 63 of the Oklahoma
Statutes this title.
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SECTION 2. AMENDATORY 63 O.S. 2011, Section 1 -890.8, as
amended by Section 1, Chapter 248, O.S.L. 2013 (63 O.S. Supp. 2020,
Section 1-890.8), is amended to read as follows:
Section 1-890.8 A. Residents of an assisted living center may
receive home care services and intermittent, periodic, or recurrent
nursing care through a home care agency under the provisions of the
Home Care Act.
B. Residents of an assisted living center may receive hospice
home services under the provisions of the Oklahoma Hospice Licensing
Act.
C. Nothing in the foregoing provisions shall be construed to
prohibit any resident of an assisted living center fr om receiving
such services from any person who is exempt from the provisions of
the Home Care Act.
D. The assisted living center shall monitor and assure the
delivery of those services. All nursing services shall be in
accordance with the written orders of the personal or attending
physician of the resident.
E. A resident of an assisted living center or the family or
legal representative of the resident shall be required to disclose
any third-party provider of medical services or supplies prior to
service delivery.
F. Any third-party provider of medical services or supplies
shall comply with the provisions of subsection D of this section.
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G. Notwithstanding the foregoing provisions, a resident of an
assisted living center, or the family or legal represe ntative of the
resident, may privately contract or arrange for private nursing
services under the orders and supervision of the personal or
attending physician of the resident, private monitoring, private
sitters or companions, personal domestic servants, or personal
staff.
H. If a resident of an assisted living center develops a
disability or a condition that is consistent with the facility 's
discharge criteria:
1. The personal or attending physician of a resident, a
representative of the assisted living center, and the resident or
the designated representative of the resident shall determine by and
through a consensus of the foregoing persons any reasonable and
necessary accommodations, in accordance with the current building
codes, the rules of the Stat e Fire Marshal, and the requirements of
the local fire jurisdiction, and additional services required to
permit the resident to remain in place in the assisted living center
as the least restrictive environment and with privacy and dignity;
2. All accommodations or additional services shall be described
in a written plan of accommodation, signed by the personal or
attending physician of the resident, a representative of the
assisted living center and the resident or the designated
representative of the res ident;
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3. The person or persons responsible for performing, monitoring
and assuring compliance with the plan of accommodation shall be
expressly specified in the plan of accommodation and shall include
the assisted living center and any of the following:
a. the personal or attending physician of the resident,
b. a home care agency,
c. a hospice, or
d. other designated persons.
The plan of accommodation shall be reviewed at least quarterly
by a licensed health care professional;
4. If the parties identifie d in paragraph 1 of this subsection
fail to reach a consensus on a plan of accommodation, the assisted
living center shall give written notice to the resident, the legal
representative or of the resident or such persons as are designated
in the resident's contract with the assisted living center, of the
termination of the residency of the resident in the assisted living
center in accordance with the provisions of the resident 's contract
with the assisted living center. Such notice shall not be less than
thirty (30) calendar days prior to the date of termination, unless
the assisted living center or the personal or attending physician of
the resident determines the resident is in imminent peril or the
continued residency of the resident places other persons at risk of
imminent harm;
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5. If any party identified in paragraph 1 of this subsection
determines that the plan of accommodation is not being met, such
party shall notify the other parties and a meeting shall be held
between the parties within ten (10) bu siness days to re-evaluate the
plan of accommodation; and
6. Any resident aggrieved by a decision to terminate residency
may seek injunctive relief in the district court of the county in
which the assisted living center is located. Such action shall be
filed no later than ten (10) days after the receipt of the written
notice of termination.
I. When an antipsychotic drug is prescribed for a resident, the
assisted living center shall do all of the following:
1. Ensure the resident is reassessed by a physi cian, physician
assistant, Advanced Practice Registered Nurse or registered nurse,
as needed, but at least quarterly, for the effectiveness and
possible side effects of the medication. The results of the
assessments shall be documented in the resident 's record and
provided to the resident or the representative of the resident;
2. Ensure all resident care staff administering medications
understand the potential benefits and side effects of the
medications; and
3. When an antipsychotic drug is prescribed o n an as-needed
basis (PRN) for a resident, the assisted living center shall:
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a. document in the resident's record the rationale for
use and a detailed description of the condition which
indicates the need for administration of a PRN
antipsychotic drug,
b. monitor the use of PRN antipsychotic drugs for
potential harm to the resident , including, but not
limited to, the presence of significant adverse side
effects, use of the drugs for inappropriate purposes
such as discipline or staff convenience, or use
contrary to the prescription . The monitoring required
by this subparagraph shall be conducted by a licensed
health care professional and shall occur at least
monthly, and
c. document in the resident's record the results of the
monitoring required in subparagr aph b of this
paragraph, including, but not limited to, the
effectiveness of the medication, the presence of any
side effects, and any inappropriate use for each PRN
antipsychotic drug given.
J. Nothing in this section shall be construed to abrogate an
assisted living center 's responsibility to provide care for and
oversight of a resident.
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SECTION 3. This act shall become effective November 1, 2021.
COMMITTEE REPORT BY: COMMITTEE ON HEALTH SERVICES AND LONG -TERM
CARE, dated 02/17/2021 - DO PASS, As Coauthored.