Oklahoma 2022 Regular Session

Oklahoma House Bill HB1877 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	An Act
2		-	ENROLLED HOUSE
	1	+
	2	+
	3	+	SENATE FLOOR VERSION - HB1877 SFLR Page 1
	4	+	(Bold face denotes Committee Amendments) 1
	5	+	2
	6	+	3
	7	+	4
	8	+	5
	9	+	6
	10	+	7
	11	+	8
	12	+	9
	13	+	10
	14	+	11
	15	+	12
	16	+	13
	17	+	14
	18	+	15
	19	+	16
	20	+	17
	21	+	18
	22	+	19
	23	+	20
	24	+	21
	25	+	22
	26	+	23
	27	+	24
	28	+
	29	+	SENATE FLOOR VERSION
	30	+	March 29, 2021
	31	+
	32	+
	33	+	ENGROSSED HOUSE
3	34		BILL NO. 1877 By: West (Tammy), Baker and
4	35		Virgin of the House
5	36
6	37		and
7	38
8	39		Coleman of the Senate
9		-
10	40
11	41
12	42
13	43
14	44
15	45		An Act relating to assisted living centers; amending
16	46		Section 1, Chapter 311, O.S.L. 2019 (63 O.S. Supp.
17	47		2020, Section 1-881), which relates to p rescribing
18	48		antipsychotic drugs to long -term care facility
19	49		residents; modifying definition; amending 63 O.S.
20	50		2011, Section 1-890.8, as amended by Section 1,
21	51		Chapter 248, O.S.L. 2013 (63 O.S. Supp. 2020, Sec tion
22	52		1-890.8), which relates to the plan of accommo dation
23	53		for certain disabled residents; modifying criteria
24	54		for prescription of antipsychotic drugs for
25	55		residents; requiring assessments and monitoring;
26	56		listing requirements; requiring documentation; and
27	57		providing an effective date.
28	58
29	59
30	60
31	61
32		-	SUBJECT: Assisted living centers
33	62
34	63		BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
35		-
36	64		SECTION 1. AMENDATORY Section 1, Chapter 311, O.S.L.
37	65		2019 (63 O.S. Supp. 2020, Section 1 -881), is amended to read as
38	66		follows:
39		-
40	67		Section 1-881. A. As used in this section:
41		-
42	68		1. "Antipsychotic drug" means a drug, sometimes called a major
43	69		tranquilizer, used to treat symptoms of severe psychiatric
	70	+
	71	+	SENATE FLOOR VERSION - HB1877 SFLR Page 2
	72	+	(Bold face denotes Committee Amendments) 1
	73	+	2
	74	+	3
	75	+	4
	76	+	5
	77	+	6
	78	+	7
	79	+	8
	80	+	9
	81	+	10
	82	+	11
	83	+	12
	84	+	13
	85	+	14
	86	+	15
	87	+	16
	88	+	17
	89	+	18
	90	+	19
	91	+	20
	92	+	21
	93	+	22
	94	+	23
	95	+	24
	96	+
44	97		disorders, including , but not limited to, schizophrenia and bipolar
45	98		disorder;
46		-	ENR. H. B. NO. 1877 Page 2
47	99		2. "Long-term care facility" means:
48		-
49	100		a. a nursing facility as defined by Section 1-1902 of
50	101		Title 63 of the Oklahoma Statutes this title,
51		-
52	102		b. the nursing facility component of a continuum of care
53	103		facility as defined under the Continuum of Care and
54	104		Assisted Living Act, or
55		-
56	105		c. the nursing care component of a life care community as
57	106		defined by the Long-term Care Insurance Act;
58		-
59	107		3. "Resident" means a resident as defined by Section 1 -1902 of
60	108		Title 63 of the Oklahoma Statutes this title;
61		-
62	109		4. "Representative of a resident " means a representative of a
63	110		resident as defined by Section 1 -1902 of Title 63 of the Oklahoma
64	111		Statutes this title; and
65		-
66	112		5. "Prescribing clinician " means:
67		-
68	113		a. an allopathic or osteopathic physician licensed by and
69	114		in good standing with the State Board of Medical
70	115		Licensure and Supervision or the State Board of
71	116		Osteopathic Examiners , as appropriate,
72		-
73	117		b. a physician assistant licensed by and in good standing
74	118		with the State Board of Medical Licensure and
75	119		Supervision, or
76	120
	121	+	SENATE FLOOR VERSION - HB1877 SFLR Page 3
	122	+	(Bold face denotes Committee Amendments) 1
	123	+	2
	124	+	3
	125	+	4
	126	+	5
	127	+	6
	128	+	7
	129	+	8
	130	+	9
	131	+	10
	132	+	11
	133	+	12
	134	+	13
	135	+	14
	136	+	15
	137	+	16
	138	+	17
	139	+	18
	140	+	19
	141	+	20
	142	+	21
	143	+	22
	144	+	23
	145	+	24
	146	+
77	147		c. an Advanced Practice Registered Nurse licensed by and
78	148		in good standing with the Oklahoma Board of Nursing.
79		-
80	149		B. Except in case of an emergency in which the resident poses
81	150		harm to the resident or others, no long -term care facility resident
82	151		shall be prescribed or administered an antipsychotic drug that was
83	152		not already prescribed to the resident prior to admission to the
84	153		facility unless each of the following conditions has been satisfied:
85		-
86	154		1. The resident has been examined by the prescribing clinician
87	155		and diagnosed with a psychiatric condition and the prescribed dru g
88	156		is approved by the United States Food and Drug Administra tion for
89	157		that condition or prescribed in accordance with generally accepted
90	158		clinical practices;
91		-	ENR. H. B. NO. 1877 Page 3
92	159		2. The prescribing clinician, or a previous prescribing
93	160		clinician, has unsuccessfully attempted to a ccomplish the drug's
94	161		intended effect using contemporary and generally accepted
95	162		nonpharmacological care options, and has documented those attempts
96	163		and their results in the resident 's medical record or has deemed
97	164		that those attempts would not be medically ap propriate based upon a
98	165		physical examination by the prescrib ing clinician and documented the
99	166		rationale in the resident 's medical record;
100		-
101	167		3. The facility has provided to the resident or representative
102	168		of a the resident a written explanation of applicable in formed
103	169		consent laws. The explanation shall be written in l anguage that the
	170	+
	171	+	SENATE FLOOR VERSION - HB1877 SFLR Page 4
	172	+	(Bold face denotes Committee Amendments) 1
	173	+	2
	174	+	3
	175	+	4
	176	+	5
	177	+	6
	178	+	7
	179	+	8
	180	+	9
	181	+	10
	182	+	11
	183	+	12
	184	+	13
	185	+	14
	186	+	15
	187	+	16
	188	+	17
	189	+	18
	190	+	19
	191	+	20
	192	+	21
	193	+	22
	194	+	23
	195	+	24
	196	+
104	197		resident or representative of a resident can be reasonably expected
105	198		to understand;
106		-
107	199		4. The prescribing clinician has confirmed with the nursing
108	200		facility verbally or otherwise that written, informed consent has
109	201		been obtained from the reside nt or representative of the resident
110	202		that meets the requirements of subsection C of this section; and
111		-
112	203		5. In the event a long -term care facility resident is
113	204		prescribed an antipsychotic medication i n the case of an emergency,
114	205		the prescribing physician shall prescribe the minimum dosage and
115	206		duration that is prudent for the resident 's condition and shall
116	207		examine the patient in person within thirty (30) days.
117		-
118	208		C. Except in the case of an emergency as pr ovided for in
119	209		subsection B of this section, the prescribing clinician shall
120	210		confirm that written, voluntary informed consent to authorize the
121	211		administration of an antipsychotic drug to a facility resident has
122	212		been obtained from the resident or the represen tative of the
123	213		resident prior to the initial administration of the antipsychotic
124	214		drug. Voluntary informed consent shall, at minimum, consist of the
125	215		following:
126		-
127	216		1. The prescribing clinician has confirmed that a signed,
128	217		written affirmation has been obtained from the resident or the
129	218		representative of the resident tha t the resident has been informed
130	219		of all pertinent information concerning the administration of an
131	220		antipsychotic drug in language that the signer can reasonably be
	221	+
	222	+	SENATE FLOOR VERSION - HB1877 SFLR Page 5
	223	+	(Bold face denotes Committee Amendments) 1
	224	+	2
	225	+	3
	226	+	4
	227	+	5
	228	+	6
	229	+	7
	230	+	8
	231	+	9
	232	+	10
	233	+	11
	234	+	12
	235	+	13
	236	+	14
	237	+	15
	238	+	16
	239	+	17
	240	+	18
	241	+	19
	242	+	20
	243	+	21
	244	+	22
	245	+	23
	246	+	24
	247	+
132	248		expected to understand. Pertinent information shall include, but
133	249		not be limited to:
134		-	ENR. H. B. NO. 1877 Page 4
135	250		a. the reason for the drug's prescription and the
136	251		intended effect of the drug on the resident 's
137	252		condition,
138		-
139	253		b. the nature of the drug and the procedure for its
140	254		administration, including dosage, administrati on
141	255		schedule, method of delivery and expected duration for
142	256		the drug to be administered,
143		-
144	257		c. risks, common side effects and potential severe
145	258		adverse reactions associated with the administration
146	259		of the drug,
147		-
148	260		d. the right of the resident or representative of th e
149	261		resident to refuse the administration of the
150	262		antipsychotic drug and the medical consequences of
151	263		such refusal, and
152		-
153	264		e. an explanation of pharmacological and
154	265		nonpharmacological alternatives to the administration
155	266		of antipsychotic drugs and the resident 's right to
156	267		choose such alternatives; and
157		-
158	268		2. Except in the case of an emergency as provided for in
159	269		subsection B of this section, the prescribing clinician shall inform
160	270		the resident or the representative of the resident of the existence
161	271		of the long-term care facility's policies and procedures for
	272	+
	273	+	SENATE FLOOR VERSION - HB1877 SFLR Page 6
	274	+	(Bold face denotes Committee Amendments) 1
	275	+	2
	276	+	3
	277	+	4
	278	+	5
	279	+	6
	280	+	7
	281	+	8
	282	+	9
	283	+	10
	284	+	11
	285	+	12
	286	+	13
	287	+	14
	288	+	15
	289	+	16
	290	+	17
	291	+	18
	292	+	19
	293	+	20
	294	+	21
	295	+	22
	296	+	23
	297	+	24
	298	+
162	299		compliance with informe d consent requirements. The facility shall
163	300		make these available to the resident or representative of the
164	301		resident prior to administering any antipsychotic drug upon request.
165		-
166	302		D. 1. Antipsychotic drug prescriptions and administration
167	303		shall be consistent w ith standards for dosage, duration and
168	304		frequency of administration that are generally accepted for the
169	305		resident's condition.
170		-
171	306		2. Throughout the duration of the administration of an
172	307		antipsychotic drug and at generally accepted intervals approved for
173	308		the resident's condition, the prescribing clinician or designee
174	309		shall monitor the resident 's condition and evaluate drug performance
175	310		with respect to the condition for which the drug was prescribed.
176	311		The prescribing clinician shall provide documentation of the sta tus
177	312		of the resident's condition to the resident or the representative of
178	313		the resident upon request and without unreasonable delay.
179		-	ENR. H. B. NO. 1877 Page 5
180	314		3. Any change in dosage or duration of the administration of an
181	315		antipsychotic drug shall be justified by the prescribing cli nician
182	316		with documentation on the resident 's record of the clinical
183	317		observations that warranted the change.
184		-
185	318		E. 1. No long-term care facility shall deny admission or
186	319		continued residency to a person on the basis of the person's or his
187	320		or her representative 's refusal to the administration of
188	321		antipsychotic drugs, unless the prescribing clinician or care
189	322		facility can demonstrate that the resident 's refusal would place the
	323	+
	324	+	SENATE FLOOR VERSION - HB1877 SFLR Page 7
	325	+	(Bold face denotes Committee Amendments) 1
	326	+	2
	327	+	3
	328	+	4
	329	+	5
	330	+	6
	331	+	7
	332	+	8
	333	+	9
	334	+	10
	335	+	11
	336	+	12
	337	+	13
	338	+	14
	339	+	15
	340	+	16
	341	+	17
	342	+	18
	343	+	19
	344	+	20
	345	+	21
	346	+	22
	347	+	23
	348	+	24
	349	+
190	350		health and safety of the reside nt, the facility staff, other
191	351		residents or visitors at risk .
192		-
193	352		2. Any care facility that alleges that the resident 's refusal
194	353		to consent to the administration of antipsychotic drugs will place
195	354		the health and safety of the resident, the facility staff, other
196	355		residents or visitors at risk shall document the alleged ri sk in
197	356		detail and shall present this documentation to the resident or the
198	357		representative of the resident, to the State Department of Health
199	358		and to the Long-Term Care Ombudsman;, and shall inform the resident
200	359		or the representative of the resident of the resi dent's right to
201	360		appeal to the State Department of Health. The documentation of the
202	361		alleged risk shall include a description of all nonpharmacological
203	362		or alternative care options attempted and why they were unsuccessful
204	363		or why the prescribing clinician det ermined alternative treatments
205	364		were not medically appropriate for the condition following a
206	365		physical examination.
207		-
208	366		F. The provisions of this section shall not apply to a hospice
209	367		patient as defined in Section 1-860.2 of Title 63 of the Oklahoma
210	368		Statutes this title.
211		-
212	369		SECTION 2. AMENDATORY 63 O.S. 2011, Section 1 -890.8, as
213	370		amended by Section 1, Chapter 248, O.S.L. 2013 (63 O.S. Supp. 2020,
214	371		Section 1-890.8), is amended to read a s follows:
	372	+	Section 1-890.8. A. Residents of an assisted li ving center may
	373	+	receive home care services and intermittent, periodic, or recurrent
215	374
216		-	Section 1-890.8 A. Residents of an assisted living center may
217		-	receive home care services and intermittent, periodic, or recurrent
	375	+	SENATE FLOOR VERSION - HB1877 SFLR Page 8
	376	+	(Bold face denotes Committee Amendments) 1
	377	+	2
	378	+	3
	379	+	4
	380	+	5
	381	+	6
	382	+	7
	383	+	8
	384	+	9
	385	+	10
	386	+	11
	387	+	12
	388	+	13
	389	+	14
	390	+	15
	391	+	16
	392	+	17
	393	+	18
	394	+	19
	395	+	20
	396	+	21
	397	+	22
	398	+	23
	399	+	24
	400	+
218	401		nursing care through a home care agency under the provisions of the
219	402		Home Care Act.
220		-
221	403		B. Residents of an assisted living center may receive hospice
222	404		home services under the pr ovisions of the Oklahoma Hospice Licensing
223	405		Act.
224		-	ENR. H. B. NO. 1877 Page 6
225	406		C. Nothing in the foregoing provisions shall be construed to
226	407		prohibit any resident of an assisted living center from receiving
227	408		such services from a ny person who is exempt from the provisions of
228	409		the Home Care Act.
229		-
230	410		D. The assisted living center shall monitor and assure the
231	411		delivery of those services. All nursing services shall be in
232	412		accordance with the written orders of the personal or attending
233	413		physician of the resident.
234		-
235	414		E. A resident of an assisted living center or the family or
236	415		legal representative of the resident shall be required to disclose
237	416		any third-party provider of medical services or supplies prior to
238	417		service delivery.
239		-
240	418		F. Any third-party provider of medical services or supplies
241	419		shall comply with th e provisions of subsection D of this section.
242		-
243	420		G. Notwithstanding the foregoing provisions, a resident of an
244	421		assisted living center, or the family or legal representative of the
245	422		resident, may privately contract or arrange for private nursing
246	423		services under the orders and supervision of the personal or
247	424		attending physician of the resident, private monitoring, private
	425	+
	426	+	SENATE FLOOR VERSION - HB1877 SFLR Page 9
	427	+	(Bold face denotes Committee Amendments) 1
	428	+	2
	429	+	3
	430	+	4
	431	+	5
	432	+	6
	433	+	7
	434	+	8
	435	+	9
	436	+	10
	437	+	11
	438	+	12
	439	+	13
	440	+	14
	441	+	15
	442	+	16
	443	+	17
	444	+	18
	445	+	19
	446	+	20
	447	+	21
	448	+	22
	449	+	23
	450	+	24
	451	+
248	452		sitters or companions, personal domestic servants, or personal
249	453		staff.
250		-
251	454		H. If a resident of an assisted living center develops a
252	455		disability or a condition that is consistent with the facility 's
253	456		discharge criteria:
254		-
255	457		1. The personal or attending physician of a resident, a
256	458		representative of the assisted living center, and the resident or
257	459		the designated representative of the resident shall determine by and
258	460		through a consensus of the foregoing persons any reasonable and
259	461		necessary accommodations, in accordance with the current building
260	462		codes, the rules of the State Fire Marshal, and the requireme nts of
261	463		the local fire jurisdiction, and additional services required to
262	464		permit the resident to remain in place in the assisted living center
263	465		as the least restrictive environment and with privacy and dignity;
264		-
265	466		2. All accommodations or additional services sh all be described
266	467		in a written plan of accommodation, signed by the personal or
267	468		attending physician of the resident, a representative of the
268	469		assisted living center and the resident or the designated
269		-	representative of the resident; ENR. H. B. NO. 1877 Page 7
270		-
	470	+	representative of the resident;
271	471		3. The person or persons responsible for performing, monitoring
272	472		and assuring complian ce with the plan of accommodation shall be
273	473		expressly specified in the plan of accommodation and shall include
274	474		the assisted living center and any of the following:
275		-
276	475		a. the personal or attending phys ician of the resident,
277	476
	477	+	SENATE FLOOR VERSION - HB1877 SFLR Page 10
	478	+	(Bold face denotes Committee Amendments) 1
	479	+	2
	480	+	3
	481	+	4
	482	+	5
	483	+	6
	484	+	7
	485	+	8
	486	+	9
	487	+	10
	488	+	11
	489	+	12
	490	+	13
	491	+	14
	492	+	15
	493	+	16
	494	+	17
	495	+	18
	496	+	19
	497	+	20
	498	+	21
	499	+	22
	500	+	23
	501	+	24
	502	+
278	503		b. a home care agency,
279		-
280	504		c. a hospice, or
281		-
282	505		d. other designated persons.
283		-
284	506		The plan of accommodation shall be reviewed at least quarterly
285	507		by a licensed health care professional;
286		-
287	508		4. If the parties identified in paragraph 1 of this subsecti on
288	509		fail to reach a consensus on a plan of accommodation, the assisted
289	510		living center shall give written notice to the resident, the legal
290	511		representative or of the resident or such persons as are designated
291	512		in the resident's contract with the assisted living center, of the
292	513		termination of the residency of the resident in the assisted living
293	514		center in accordance with the provisions of the resident 's contract
294	515		with the assisted living center. Such notice shall not be less than
295	516		thirty (30) calendar days prior to the date of termination, unless
296	517		the assisted living center o r the personal or attending physician of
297	518		the resident determines the resident is in imminent peril or the
298	519		continued residency of the resident places other persons at risk of
299	520		imminent harm;
300		-
301	521		5. If any party identified in paragraph 1 of this subsection
302	522		determines that the plan of accommodation is not being met, such
303	523		party shall notify the other parties and a meeting shall be held
304	524		between the parties within ten (10) business days to re -evaluate the
305	525		plan of accommodation; and
306	526
	527	+	SENATE FLOOR VERSION - HB1877 SFLR Page 11
	528	+	(Bold face denotes Committee Amendments) 1
	529	+	2
	530	+	3
	531	+	4
	532	+	5
	533	+	6
	534	+	7
	535	+	8
	536	+	9
	537	+	10
	538	+	11
	539	+	12
	540	+	13
	541	+	14
	542	+	15
	543	+	16
	544	+	17
	545	+	18
	546	+	19
	547	+	20
	548	+	21
	549	+	22
	550	+	23
	551	+	24
	552	+
307	553		6. Any resident aggrieved by a dec ision to terminate residency
308	554		may seek injunctive relief in the district court of the county in
309	555		which the assisted living center is located. Such action shall be
310	556		filed no later than ten (10) days after the receipt of the written
311	557		notice of termination.
312		-
313	558		I. When an antipsychotic drug is prescribed for a resident, the
314		-	assisted living center shall do all of the following: ENR. H. B. NO. 1877 Page 8
315		-
	559	+	assisted living center shall do all of the following:
316	560		1. Ensure the resident is reassessed by a physician, physician
317	561		assistant, Advanced Practice Registered Nurse or registered nurse,
318	562		as needed, but at least quarterly, for the effectiveness and
319	563		possible side effects of the medication. The results of the
320	564		assessments shall be documented in the resident 's record and
321	565		provided to the residen t or the representative of the resident;
322		-
323	566		2. Ensure all resident care staff administering medications
324	567		understand the potential benefits and side effects of the
325	568		medications; and
326		-
327	569		3. When an antipsychotic drug is prescribed on an as -needed
328	570		basis (PRN) for a resident, the assisted living center shall:
329		-
330	571		a. document in the resident's record the rationale for
331	572		use and a detailed description of the condition which
332	573		indicates the need for administration of a PRN
333	574		antipsychotic drug,
	575	+	b. monitor the use of PRN antipsycho tic drugs for
	576	+	potential harm to the resident including, but not
334	577
335		-	b. monitor the use of PRN antipsychotic drugs for
336		-	potential harm to the resident , including, but not
	578	+	SENATE FLOOR VERSION - HB1877 SFLR Page 12
	579	+	(Bold face denotes Committee Amendments) 1
	580	+	2
	581	+	3
	582	+	4
	583	+	5
	584	+	6
	585	+	7
	586	+	8
	587	+	9
	588	+	10
	589	+	11
	590	+	12
	591	+	13
	592	+	14
	593	+	15
	594	+	16
	595	+	17
	596	+	18
	597	+	19
	598	+	20
	599	+	21
	600	+	22
	601	+	23
	602	+	24
	603	+
337	604		limited to, the presence of significant adverse side
338	605		effects, use of the drugs for inappropriate purposes
339	606		such as discipline or staff convenience, or use
340	607		contrary to the prescription . The monitoring required
341	608		by this subparagraph shall be conducted by a licensed
342	609		health care professional and shall occur at least
343	610		monthly, and
344		-
345	611		c. document in the resident's record the results of the
346	612		monitoring required in subparagraph b of this
347		-	paragraph, including, but not limited to, the
	613	+	paragraph including, but not limited to, the
348	614		effectiveness of the medication, the presence of any
349	615		side effects, and any inappropriate use for each PRN
350	616		antipsychotic drug given.
351		-
352	617		J. Nothing in this section shall be construed to abrogate an
353	618		assisted living center 's responsibility to provide care for and
354	619		oversight of a resident.
355		-
356	620		SECTION 3. This act shall become effective November 1, 2021.
357		-	ENR. H. B. NO. 1877 Page 9
358		-	Passed the House of Representatives the 1st day of March, 2021.
359		-
360		-
361		-
362		-
363		-	Presiding Officer of the House
364		-	of Representatives
365		-
366		-
367		-	Passed the Senate the 12th day of April, 2021.
368		-
369		-
370		-
371		-
372		-	Presiding Officer of the Senate
373		-
374		-
375		-
376		-	OFFICE OF THE GOVERNOR
377		-	Received by the Office of the Governor this ____________________
378		-	day of ___________________, 20_______, at _______ o'clock _______ M.
379		-	By: _________________________________
380		-	Approved by the Governor of the State of Oklahoma this _________
381		-	day of ___________________, 20_______, at _______ o'clock _______ M.
382		-
383		-
384		-	_________________________________
385		-	Governor of the State of Oklahoma
386		-
387		-	OFFICE OF THE SECRETARY OF STATE
388		-	Received by the Office of the Secretary of State this __________
389		-	day of ___________________, 20_______, at _______ o'clock _______ M.
390		-	By: _________________________________
391		-
	621	+	COMMITTEE REPORT BY: COMMITTEE ON HEALTH AND HUMAN SERVICES
	622	+	March 29, 2021 - DO PASS