Basic CDR Services
Effective January 1, 2025, AB 2376 expands the basic CDR services that a CDRH, or a GACH or APH with a supplemental CDR service, must provide to also include MAT and medically supervised voluntary inpatient detoxification. This bill excludes emergency department services or medical inpatient admission for treatment of severe, potentially life-threatening intoxication and withdrawal syndromes from the basic CDR services.
Definitions:
- “Medically supervised voluntary inpatient detoxification” includes “medical detoxification,” Title 22 of the California Code of Regulations (CCR) section 79021, which is the administration of any medication for the specific purpose of managing and/or preventing withdrawal syndrome performed by a qualified physician, or by qualified health care personnel under the supervision of a qualified physician, to an inpatient who is not receiving involuntary treatment pursuant to Chapter 2 of Part 1 of Division 5 of the Welfare and Institutions Code.
- “Withdrawal syndrome” has the same meaning as defined in Title 22 CCR section 79077.
- “Medications for addiction treatment” means the use of medications approved by the United States Food and Drug Administration and administered for the specific purpose of managing and/or preventing withdrawal syndrome and treating substance use disorders.
- “Distinct part” means an identifiable unit of a hospital or a freestanding facility accommodating beds, and related services, including, but not limited to, contiguous rooms, a wing, a floor, or a building that is approved by the department for a specific purpose (Title 22 CCR sections 70027 and 71027). A distinct part may not be licensed under another distinct part of a health facility.
CDR Supplemental Service Expansion
Hospitals intending to provide CDR services without operating a distinct part or outside of a distinct part are not exempt from the requirement to have CDR listed as a supplemental service on their license. Hospitals must apply to CDPH to provide CDR services and meet all other statutes and regulations applicable to CDRHs, which includes having designated locations for patient counseling, group therapy, physical conditioning, family therapy, and outpatient services.
As amended by AB 2376, HSC section 1250.3 specifies that a hospital may provide CDR services without a distinct part or outside of the hospital’s distinct part in beds that are licensed for a different service if the hospital does both of the following:
- Requires all staff treating a patient receiving CDR services to have the appropriate competencies for CDR and for other care they provide in the unit where the patient has been placed consistent with their role in patient care.
- Meets the nurse-to-patient staffing ratios for the unit where the patient has been placed.
Location Requirements
The hospital must develop and implement policies and procedures to ensure adequate safety and security for all patients placed in a unit where CDR services may be provided. The policies and procedures must include a process for the safe transfer of patients to the designated locations and to cohort CDR patients as much as possible.
Beds specifically designated for CDR as a supplemental service on a hospital’s license may not be used for other services.
CDR services may be provided in a freestanding facility or within a hospital building.[1] AB 2376 allows CDR services to be co-located with other services of the parent GACH or APH. GACHs and APHs may provide CDR as a supplemental service within the same building or in a separate building on campus if that separate building meets the requirements of a freestanding CDRH described in the OSHPD 6 requirements in the California Building Standards Code, Title 24 of the California Code of Regulations. Questions concerning the OSHPD 6 requirements for CDRHs should be directed to the Department of Health Care Access and Information regsunit@hcai.ca.gov.
Nursing Staff Requirements
A hospital must continue to meet the minimum nurse-to-patient staffing ratios for the unit in which the patient has been placed; however, if the acuity of the patient(s) is higher due to co-occurring disorders and/or illnesses, the hospital must staff additional nurses beyond the minimum ratios sufficient to ensure safe and appropriate patient care. Hospitals must also employ their method for determining staffing requirements based on assessment of patient needs (e.g., patient classification system) to determine appropriate staffing for units where patients are receiving CDR services outside of a distinct part.
All nurses treating patients receiving CDR services outside of a distinct part must have competencies in both CDR services and the services for which the unit is licensed. Hospitals must update their policies and procedures that contain competency standards for staff performance in the delivery of patient care for each affected unit to reflect CDR service competencies, including but not limited to minimum education, training, licensing, and experience requirements.
Documentation Requirements
Upon request, hospitals must provide the department with the census and location of patients receiving CDR services and nurses providing care to those patients with relevant competencies. This census must be updated continually and must be immediately available.
Confidentiality Protections
The information in this AFL is a brief summary of the provisions of AB 2376. Facilities are responsible for following all applicable laws. CDPH’s failure to expressly notify facilities of statutory or regulatory requirements does not relieve facilities of their responsibility for following all laws and regulations. Facilities should refer to the full text of all applicable sections of the HSC and the CCR to ensure compliance.
Sincerely,
Original signed by Mandi Posner
Mandi Posner
Deputy Director
[1] HSC 1250.3(f)