Termination and Discharge

(A) The Licensed or Approved Provider shall establish written termination and discharge policies and procedures and shall make these available to prospective patients or residents at the time of admission. These shall include: (1) Written criteria defining: (a) Successful completion of treatment; (b) Voluntary termination prior to program completion, except in the case of an individual committed to treatment under M.G.L. c. 123, § 35; (c) Involuntary termination, including: 1. emergency termination when the program director or Practitioner reasonably determines that the patient's or resident's continued presence in the program presents an immediate and substantial threat of physical harm to other patients or residents, program personnel, or property; and 2. nonemergency termination, including notice to the patient or resident of the reasons for termination and the right to grieve the decision as required by 105 CMR 164.080 prior to termination; and (d) Procedures for determining, in consultation with the patient or resident, referrals needed to ensure a continuum of care, reduction of risk of relapse, and reduction of risks to patient's or resident's well-being, provided the patient or resident is directly connected to such services prior to or within a reasonable time following discharge. Such referrals may include, but are not limited to: 1. certified alcohol and drug-free housing; 2. additional substance use disorder treatment; 3. treatment of co-occurring disorders; 4. continued care coordination and management with the patient's or resident's medical and psychiatric care providers; 5. community based overdose prevention programs; 6. employment resource; 7. community and social supports, including family support services; and 8. providers of medication for addiction treatment. (2) Procedures for planning the discharge in consultation with the patient or resident when one of the following conditions is met and discharge will not create an immediate safety risk for the patient: (a) Patient or resident has received optimum benefit from treatment and further progress requires either the patient's or resident's return to the community or the patient's or resident's referral to another type of treatment program; (b) Patient or resident is ready to transition to different service type, which may be more or less intensive than the current program; (c) Patient or resident voluntarily requests discharge from treatment, in which case procedures shall include review of risks and benefits of terminating treatment; or (d) Patient or resident is involuntarily terminated on a nonemergency basis. (3) A written discharge summary, including: (a) Description of services provided, patient's or resident's response to such services, and progress in attaining treatment plan goals; (b) Patient's or resident's substance use at discharge, including risk of overdose and recommendations for follow-up services; (c) Patient's or resident's current vocational, educational and financial status; (d) Reason for termination; (e) Direct referrals provided; (f) Supports and services available to the patient or resident after discharge, provided by the Licensed or Approved Provider or by others; (g) Documentation of efforts made by the Licensed or Approved Provider to prevent discharge of a patient or resident to a shelter for the homeless; (h) Documentation of patient's or resident's participation in discharge planning, or of patient's or resident's refusal to participate; and (i) An aftercare and follow-up plan, including method for contacting patient or resident if the patient or resident consents to contact. (B) The Licensed or Approved Provider shall establish procedures for discharge if a patient or resident leaves the program against clinical advice or is involuntarily discharged from the program including, but not limited to, an appeal process for an involuntary discharge. The Licensed or Approved Provider shall refer the patient or resident to another facility/program for treatment if necessary or appropriate. (C) Licensed or Approved Providers may discharge patients or residents who refuse to provide information required for necessary coordination of treatment or in an emergency situation where the patient's or resident's continuation in the program presents an immediate and substantial threat of physical harm to other patients or residents, program personnel or property; provided the Licensed or Approved Provider shall maintain documentation related to involuntary discharges, to include reasons for involuntary discharge and referrals made, and shall make this documentation available to the Department for inspection. (D) Licensed or Approved Providers providing Opioid Treatment Services shall establish additional termination and discharge procedures as specified in 105 CMR 164.311. (E) Licensed or Approved Providers providing residential services, whether acute or rehabilitation, shall not develop a discharge plan which provides for discharge of a patient or resident or patient to a shelter for the homeless.