Section R9-21-312. Inpatient Treatment and Discharge Plan

A.       General provisions.

1.        Every client of an inpatient facility shall have an Inpatient Treatment and Discharge Plan (ITDP).

2.        An ITDP shall be developed by the inpatient facility’s treatment team, the case manager and other members of the clinical team, as appropriate.

3.        The ITDP shall include the most appropriate and least restrictive services available at the inpatient facility, as well as a plan for the client’s discharge to the community.

4.        The ITDP shall identify those treatment interventions and services which maximize the client’s strengths, indepen- dence, and integration into the community.

5.        The ITDP shall be developed with the fullest possible participation of the client and any designated representa- tive and/or guardian.

6.        The ITDP shall contain goals and objectives which are measurable and which facilitate meaningful evaluation of the progress toward attaining those goals and objectives.

7.        The ITDP shall be written in language which can be eas- ily understood by a lay person.

8.        Delays in the assignment of a case manager or in the development or modification of an ISP or ITDP shall not be construed to prevent the appropriate discharge of a cli- ent from an inpatient facility.

B.       The individual treatment and discharge plan meeting.

1.        The case manager shall encourage the client to have a designated representative assist the client at the meeting and to have other persons, including family members, attend the meeting. The case manager shall ensure that

the human rights advocate is notified of the time and date of the ITDP for clients who need special assistance.

2.        The following persons shall be invited to attend the ITDP meeting:

a.        The client;

b.        Any designated representative and/or guardian;

c.        Family members, with the client’s permission;

d.        Members of the client’s inpatient facility treatment team;

e.        The case manager and other members of the clinical team, as appropriate;

f.         Other persons familiar with the client whose pres- ence at the meeting is requested by the client; and

g.        Any other person whose participation is not objected to by the client and who will, in the judgment of the case manager, contribute to the ITDP meeting.

3.        The ITDP meeting shall include a discussion of:

a.        A review of the ISP’s long-term view;

b.        If necessary, a new functional assessment of the sup- ports or skills necessary to achieve the client’s long- term view;

c.        The client’s needs in terms of assessed strengths and needs;

d.        The client’s preferences regarding services;

e.        Existing services if any;

f.         The procedure for completion and implementation of the ITDP process, including the procedures for accepting, rejecting, or appealing the ITDP;

g.        The procedure for clients or the inpatient facility to request changes in the ITDP; and

h.        The methods to ensure that services are provided as set forth in the ITDP and regularly monitored for effectiveness.

C.       Inpatient treatment and discharge plan.

1.        The facility treatment team, the case manager, and other representatives of the clinical team, as appropriate, shall develop a preliminary ITDP within three days, and a full ITDP within seven days thereafter, of the client’s admis- sion. Where a client’s anticipated stay is less than seven days, an acute inpatient facility shall develop a prelimi- nary ITDP within one day and a full ITDP within three days of a client’s admission.

2.        The ITDP shall be consistent with the goals, objectives, and services set forth in the client’s ISP and shall be incorporated into the ISP.

3.        The ITDP shall include:

a.        The client’s preferences, strengths, and needs;

b.        A description of appropriate services to meet the cli- ent’s needs;

c.        For non-acute facilities, long-range goals which will assist the client in attaining the most self-fulfilling, age-appropriate, and independent style of living pos- sible, stated in terms which allow objective mea- surement of progress and which the client, to the maximum extent possible, both understands and accepts;

d.        Short-term objectives that lead to attainment of overall goals stated in terms which allow objective measurement of progress and which the client, to the maximum extent possible, both understands and accepts;

e.        Expected dates of completion for each objective;

f.         Persons responsible for each objective;

g.        The person responsible for ensuring that services are actually provided and are regularly monitored; and

h.        The right of the client or guardian to accept or reject the ITDP, request other services, or appeal the ITDP or any aspect of the ITDP.

D.       Preparation and distribution of the ITDP.

1.        Within three days of the ITDP meeting, the treatment team coordinator shall prepare and distribute the ITDP.

2.        The ITDP shall be personally presented and explained to the client by the case manager.

3.        The ITDP shall be mailed or otherwise distributed to the following persons:

a.        The client’s designated representative and guardian, if any;

b.        The case manager and members of the clinical team; and

c.        The members of the inpatient facility’s treatment team.

E.       Acceptance or rejection of the ITDP.

1.        Within two days of the date when the ITDP was distrib- uted, the client shall be contacted by the case manager concerning acceptance or rejection of the ITDP, if there has not been acceptance or rejection prior to that date.

2.        If the client or guardian does not object to the ITDP within 10 days of the date when the ITDP was distrib- uted, the client shall be deemed to have accepted the ITDP.

3.        If the client or guardian rejects some or all of the treat- ment interventions or services identified in the ITDP or requests other services, the case manager shall provide written notice to the client of the right to meet with the treatment team coordinator within five days of the rejec- tion to discuss the plan and to suggest modifications, or to immediately appeal the plan according to R9-21-401.

4.        If modifications are agreed to by the treatment team coor- dinator and the client or guardian, the treatment team coordinator shall arrange for approval of the modifica- tions by all members of the inpatient facility’s treatment team, the case manager, and members of the clinical team, as appropriate.

5.        If the matter is not resolved to the client’s or guardian’s satisfaction, the case manager shall again inform the cli- ent and guardian of the right to appeal according to R9- 21-401. The client or guardian may appeal findings or recommendations in the ITDP within 30 days of receipt of the plan.

6.        A client or guardian who rejects the ITDP may accept some or all of the identified treatment interventions or services pending the outcome of the meeting with the treatment team coordinator or an appeal.

F.       The updated ITDP. The facility treatment team, the case man- ager, and other representatives of the clinical team, as appro- priate, shall review the ITDP as frequently as necessary, but at least once within the first 30 days of completing the plan, every 60 days thereafter during the first year, and every 90 days thereafter during any subsequent years that the client remains a resident of the facility.

G.      Incorporation into the individual service plan.

1.        If the clinical team determines that the ITDP is appropri- ate to meet the client’s needs, least restrictive of the cli- ent’s freedom, and consistent with the ISP, it shall approve the ITDP by incorporating it into the ISP. If the clinical team disapproves the ITDP, it shall convene an ISP meeting, which includes the inpatient facility treat- ment team, to prepare a revised ITDP.

2.        The clinical team, with the assistance of the inpatient facility’s treatment team, shall be responsible for imple- menting the plan for the client’s discharge.

3.        The case manager will provide notice to those providers identified in the client’s ISP three days prior to the cli- ent’s actual discharge, except that the failure to provide such notice shall not delay discharge.

4.        The case manager shall meet with the client within five days of the client’s discharge to ensure that the ISP is being implemented.

5.        The case manager shall review the ISP with the clinical team within 30 days of the discharge to determine whether any modifications are appropriate, consistent with the standards and requirements set forth in R9-21- 314.

Historical Note

Adopted under an exemption from A.R.S. Title 41, Chap- ter 6 pursuant to Laws 1992, Ch. 301, § 61, effective October 7, 1992; received in the Office of the Secretary of State October 14, 1992 (Supp. 92-4). Amended under an exemption from A.R.S. Title 41, Chapter 6 pursuant to Laws 1992, Ch. 301, § 61, effective September 30, 1993 (Supp. 93-3). Amended by exempt rulemaking at 9

A.A.R. 3296, effective June 30, 2003 (Supp. 03-2).