In California

Answer from Rudy via email: California Health and Safety Code 11834.026 states Programs may offer and provide Incidental Medical Services (IMS) as part of their licensure. IMS are defined as “services that are in compliance with the community standard of practice and are not required to be performed in a licensed clinic or licensed health facility… to address medical issues associated with either detoxification from alcohol or drugs or the provision of alcoholism or drug abuse recovery or treatment services…” While providing IMS, Healthcare Professionals (HCPs) are permitted to “oversee patient self-administered medications.” While there are instances in which specific medications like Vivitrol require an HCP to directly administer an injection, typically, if a client is unable to self-administer their medications, they would most likely be referred to a higher level of care. For clarification, DHCS does not license “medical SUD facilities.”

Source:

• Licensing and Certification Division via email on January 8, 2024

  California Health and Safety Code 11834.026

Talking Points for Facilities Regarding Self-Infusion

• “Just so you’re aware, clients are permitted to self-administer infusion and injection medications when supervised by a health care professional, per California Health and Safety Code 11834.026. Medication administration for non-behavioral health indications, like a bleeding disorder, is considered an incidental medical service (IMS) and facilities are allowed to offer these services.”

• "[Insert patient name] is fully competent to self-administer their medication from a bleeding disorders perspective."

• "My patient has been independent with [his/her/their] self-infusions since age [insert age] and self-administers regularly in community settings without any medical oversight."

• "I would be happy to provide a letter confirming [insert patient name]’s ability to self-administer their medication from a bleeding disorders perspective."

• "However, it will be important for your team to assess whether [insert patient name] is currently able to safely self-administer in the context of this [mental health and/or substance use] crisis. Factors to consider in this assessment include:

  • [Insert patient name]’s current mental state (e.g., psychosis, delusions, agitation);

    • Whether [he/she/they] has expressed any intent to use bleeding disorder supplies to harm self or others;

    • Demonstrated ability to engage in safe behaviors;

    • Willingness and desire to self-infuse; and

    • Whether the use of needles could be triggering in the current context."

• "If your team determines that [insert patient name] is capable of self-administering from a behavioral health perspective, the facility will need to provide staff oversight during the infusion. This is to ensure that:

  • The medication is administered exactly as directed by the bleeding disorder treatment team, and

  • Supplies are used only for their intended medical purpose."

• "I would be happy to provide more detailed information about the infusion process or send you a video so your staff can be familiar with what to expect."

• “If your team determines that [insert patient name] is not capable of self-administering from a behavioral health perspective, then we will need to identify a trained individual who is capable of administering the medication to him/her/them. I am happy to work with you to identify an appropriate individual.”

• If your facility does not currently have established policies and procedures that allow for self-administration, but you are open to permitting it, we can send you some sample language of self-administration policies for you to consider.

• Patient Self-Infusion and Medical Stability letter: Use this template to reassure the facility that the individual is stable and capable of self-infusing from a bleeding Add the following:

  “Just so you’re aware, clients are permitted to self-administer infusion and injection medications when supervised by a health care professional (HCP), per California Health and Safety Code 11834.026. Medication administration for non-behavioral health indications, like a bleeding disorder, is considered an incidental medical service (IMS) and facilities are allowed to offer these services. This has been confirmed in discussions with the Licensing and Certification Division within the CA Department of Health Care Services.”

• Excerpt from MASAC Document #289:This provides information about infusions for people with bleeding disorders from national bleeding disorders experts.

• Sample self-administration policy: If the facility does not have a policy permitting medication self-administration but is open to adopting one, this is a sample policy that you can offer them as a place to start.

• “How to give factor by peripheral infusion:” If the staff wants to see an example of what a peripheral infusion looks like in bleeding disorders, you can send this video from Minnesota Children’s. 

• “How to give a subcutaneous injection:” If the staff wants to see an example of what a subcutaneous injection looks like in bleeding disorders, you can send this video from Minnesota Children’s.