A4522

An Act concerning hospice care and supplementing Title 26 of the Revised Statutes.

Be It Enacted by the Senate and General Assembly of the State of New Jersey:

1. a. As used in this section:

“Family member” means a hospice care patient’s spouse, parent, adult sibling, adult child, or adult grandchild.

“Health care representative” means a person, including a member of the patient’s family, who is authorized to make health care decisions on behalf of a hospice care patient.

“Hospice care patient” means a person currently receiving hospice care services in a private home or an assisted living facility through a licensed hospice care program.

“Third party caregiver” means a person who:

(1) is 18 years of age or older;

(2) provides care or assistance to a hospice care patient; and

(3) is not the patient’s health care representative, a family member of the patient, or employed by the patient’s hospice care program.

b. A hospice care program licensed pursuant to P.L.1997, c.78 (C.26:2H-79 et seq.) may choose, but shall not be required, to accept for disposal, at such time as a hospice care patient ceases to receive hospice care services through the program, the hospice care patient’s unused prescription medications. A hospice care program that chooses to accept unused prescription medications for disposal pursuant to this section shall:

(1) Establish a written policy setting forth procedures for accepting and disposing of unused prescription medications;

(2) Furnish a copy of the written policy to each patient, and to the patient’s health care representative, at the time the patient is enrolled in the hospice care program, and designate a program representative who shall discuss the procedures and requirements for surrendering unused prescription medications with the patient and the patient’s health care representative;

(3) Accept medications prescribed and dispensed to the patient pursuant to the patient’s hospice care plan, as well as any other prescription medications that the patient, or the patient’s health care representative, chooses to surrender to the program;

(4) Not accept any medication for surrender except at such time as the patient ceases to receive hospice care services through the program; and

(5) Obtain any certifications, authorizations, or waivers as may be required under State or federal law in order to accept and dispose of unused prescription medications pursuant to this section.

c. At the time a hospice care patient ceases to receive hospice care services, a program representative shall provide a written request for surrender of unused medication to the patient or the patient’s health care representative, which shall:

(1) request that the patient or the patient’s health care representative surrender any unused prescription medications that were prescribed and dispensed to the patient pursuant to the patient’s hospice care plan;

(2) offer to accept and dispose of any other prescription medication which the patient will not use; and

(3) urge that the patient or the patient’s health care representative dispose of any unused prescription medication that is not surrendered to the program in a safe and legal manner, so as to avoid the risk of theft, diversion, or accidental ingestion.

d. No hospice care program may accept and dispose of an unused prescription medication pursuant to this section unless the patient or the patient’s health care representative authorizes, in writing, the surrender of the unused prescription medication to the program; except that, if the patient is unable to provide written authorization and the patient does not have a health care representative, a third party caregiver may provide written authorization for the surrender. A hospice care program shall not accept an unused prescription medication unless the medication is identified for inclusion in the authorization for surrender.

e. (1) Unused prescription medications surrendered to a hospice care program pursuant to this section shall be surrendered to a registered professional nurse or a licensed practical nurse employed by the program.

(2) A nurse accepting the surrender of unused prescription medication pursuant to this section shall dispose of the medications at the site where hospice care was provided; in no case shall the nurse transport the unused prescription medications off-site for disposal or for any other purpose.

(3) A nurse who accepts and disposes of an unused prescription medication pursuant to this section shall document:

(a) the name and quantity of each medication surrendered;

(b) the name of the person authorizing the surrender, and the relationship of the person to the patient;

(d) the quantity and type of any unused prescription medication, of which the nurse is aware, that was prescribed and dispensed to the patient pursuant to the patient’s hospice care plan, but was not surrendered to the program or otherwise disposed of by another person in the nurse’s presence.

(4) The person authorizing the surrender of medication shall be provided with the opportunity to review, verify, and sign the documentation required under paragraph (3) of this subsection.

f. Nothing in this section shall prohibit any person from disposing of an unused prescription medication by any means authorized by law, including, but not limited to, surrendering the medication at a secure prescription medication drop-off receptacle.

g. No person shall be subject to civil or criminal liability or professional disciplinary action for any act or omission undertaken in good faith consistent with the requirements of this section.

2. The Commissioner of Health, pursuant to the “Administrative Procedure Act,” P.L.1968, c.410 (C.52:14B-1 et seq.), shall adopt rules and regulations to effectuate the purposes of this act.

3. This act shall take effect the first day of the seventh month next following the date of enactment, except that the Commissioner of Health may take any advance administrative action as shall be necessary to effectuate the provisions of this act.

STATEMENT

This bill authorizes licensed hospice care programs to accept unused prescription medications for disposal under certain circumstances. Specifically, a hospice care program may voluntarily choose to accept for disposal, at such time as a hospice care patient receiving hospice services in an assisted living facility or private residence ceases to receive such services, any unused medications that were prescribed to the patient.

A licensed hospice care program that chooses to accept unused prescription medications for disposal will be required to establish a written policy setting forth the procedures for accepting unused prescription medications, which is to be furnished to each patient, and the patient’s health care representative, at the time the patient is enrolled in the hospice care program. Additionally, at the time of enrollment, a program representative is to discuss the procedures and requirements for surrendering unused prescription medications with the patient and the patient’s health care representative. Hospice care programs that choose to accept unused prescription medications for disposal will additionally be required to obtain any certifications, authorizations, and waivers as may be required under State or federal law in order to accept and dispose of unused prescription medications. A hospice care program may not accept any medication for surrender except at such time as the patient ceases to receive hospice care services.

At the time a patient ceases to receive hospice care services from a program that accepts unused prescription medications for disposal, a program representative will be required to provide the patient or the patient’s health care representative with a written request for the surrender of unused medications, which will include: (1) a request that any unused prescription medications prescribed and dispensed to the patient pursuant to the patient’s hospice care plan be surrendered to the program; (2) an offer to accept any other prescription medications that the patient will not use; and (3) a recommendation that the patient or the patient’s health care representative dispose of any unused prescription medications that are not surrendered to the program in a safe and legal manner, so as to avoid the risk of theft, diversion, or accidental ingestion.

The bill requires a hospice care program to obtain written authorization from the patient or the patient’s health care representative prior to accepting an unused prescription medication for disposal. If the patient is unable to provide written authorization, and the patient does not have a health care representative, a third party caregiver, who is defined in the bill as a person 18 years of age or older who provides care and services to the patient but is not the patient’s health care representative, a family member of the patient, or employed by the patient’s hospice care program, will be permitted to provide authorization. No medication may be accepted for disposal by a hospice care program unless it is identified for inclusion in an authorization for surrender.

Under the bill, unused prescription medications may only be surrendered to a registered professional nurse or licensed practical nurse employed by the hospice care program. Any medication surrendered to the program is to be disposed of at the site where the patient was receiving hospice care services, and in no case may a surrendered medication be transported off site.

A nurse accepting the surrender of an unused prescription medication will be required to document: the name and quantity of each medication surrendered; the name of the person providing the authorization and the relationship of that person to the patient; the date and method of disposal; and any unused prescription medication that the nurse is aware of that was provided to the patient pursuant through the program but was not surrendered to the program or otherwise disposed of by another person in the nurse’s presence. The person providing authorization will have the opportunity to review, verify, and sign this documentation.

Nothing in the bill will prevent any person from disposing of an unused prescription medication by any means authorized by law, including, but not limited to, surrender to a secure prescription drop-off receptacle. The bill provides immunity from civil and criminal liability for any act or omission undertaken in good faith consistent with the provisions of the bill.

Hospice care patients are often prescribed a number of medications, which may include powerful opioid analgesics used to manage pain symptoms. It is the sponsor’s belief that allowing hospice care programs to accept a hospice care patient’s unused prescription medications may help ensure the safe and speedy disposal of these medications, thereby reducing the risk that the medications may be stolen, diverted, or accidentally ingested.