This clarifies a SNF or ICF IDT’s authority to administer antipsychotic medications and create or change certain orders according to HSC section 1418.9. It supersedes AFL 20-83.1.

The resident representative serving as part of the IDT must be unaffiliated with the facility.

The date by which facilities must identify a patient representative before the facility may initiate an IDT to make treatment decisions pursuant to HSC section 1418.8 has been extended to January 27, 2023.

HSC section 1418.8 authorizes an IDT at a SNF or ICF to make treatment decisions for residents when a physician determines the resident is unable to provide informed consent for a proposed treatment intervention because they cannot articulate a decision or cannot understand the risks or benefits of a proposed intervention and where the resident has no health care decision maker to consent to the proposed intervention. The Court of Appeal decision upheld the constitutionality of the HSC section.

SNFs and ICFs are required to provide both verbal and written notice to a resident before administering a treatment intervention or a change in treatment that an IDT authorized, except in cases of emergency. SNFs and ICFs can continue providing IDT medical treatment interventions to those residents already receiving such treatment before June 16, 2022. Facilities must provide verbal and written notice to residents already receiving treatments and must provide updated verbal and written notice upon any changes in treatment.

Except in cased of emergency, before initiating and administering any IDT authorized medical treatment requiring informed consent a SNF or ICF shall do all of the following:

(1) Provide written and verbal notice to the resident which shall include:

· The physician's determinations regarding the resident's inability to provide informed consent for a proposed medical treatment intervention;

· The proposed medical treatment intervention;

· The lack of a health care decision maker available for the resident and a description of the facility's eff orts to locate a health care decision maker for the resident;

· An explanation of the IDT process and how the IDT will make treatment decisions for the resident until the resident regains the ability to provide informed consent;

· That a resident representative of the resident's choosing shall participate as a member of the IDT; and

· That the resident may seek judicial adjudication of the physician's and the IDT's determinations.

Further, before administering a medical intervention, except in cases of emergency, the written notice to the resident. shall be concurrently provided to a competent person whose interests are aligned with the resident.

(2) Provide written notice to a competent person whose interests are aligned with a resident or to a local ombudsman who may be the following:

· A competent friend or family member for whom the resident provides written authorization for the release and sharing of the resident's confidential medical information and to receive the written notice; or

· A competent person or entity authorized by law.

If, after reasonably diligent efforts, a facility is unable to locate a competent person whose interests are aligned with the resident's or the resident cannot provide authorization or consent for a person to receive confidential medical information and the written notice, the facility may send the written notice to the local ombudsman in the county in which the facility is located.

(3) Include a patient representative on the IDT

Whenever the resident has no family or friend willing to serve on the IDT, someone unaffiliated with the facility must be found to serve as the patient representative

(4) Provide a reasonable opportunity for judicial review to a resident

SNFs and ICFs should update, develop, adopt, and implement policies and procedures to ensure compliance with requirements for residents

In the event an IDT is convened for a resident under HSC 1418.8, facilities shall maintain documentation in the medical record of all the following.

CDPH will verify compliance with requirements of HSC section 1418.8 during periodic surveys and complaint investigations.

AFL 11-08 and AFL 11-31 provide guidance on the interpretation and implementation of T22 §72528(c) pertaining to informed consent.

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