MA Gen L ch 111 § 51 1/2(b)

• In 2016, the state enacted the STEP Act, which requires that a person presenting in an acute-care hospital or a satellite emergency facility, whom the attending physician reasonably believes to be experiencing an overdose involving an opioid, or who has received a naloxone administration prior to arriving at the hospital or facility, receive a substance abuse evaluation within 24 hours of receiving emergency room services.
• The law requires that a substance abuse evaluation conclude with a diagnosis of the status and nature of the patient’s SUD using standardized definitions as set forth in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, or a mental or behavioral disorder due to the use of psychoactive substances, as the World Health Organization defines and codes it. Furthermore, each patient must receive the findings of the evaluation in person and in writing, and such findings must include recommendations for further treatment, if necessary, with an assessment of the appropriate level of care needed.
• The STEP Act also prohibits an acute-care hospital or satellite emergency facility from permitting discharge less than 24 hours after admission or before the conclusion of a substance abuse evaluation, whichever comes sooner. If a patient does not receive an evaluation within 24 hours, the attending physician must note in the medical record the reason the evaluation did not occur and authorize the discharge of the patient.
• Finally, a patient may consent to further treatment after the provider performs a substance abuse evaluation. Should a patient refuse further treatment after the evaluation is complete, and otherwise be medically stable, the hospital or facility may initiate discharge proceedings. The patient, however, must receive information on local and statewide treatment options upon discharge, and any other information the attending physician deems appropriate.

MA Gen L ch 111 § 25J 1/2

• This law enacted in August 2018 builds on the STEP Act’s warm handoff provisions. It requires hospitals with emergency departments (as well as satellite facilities) to maintain the capacity to provide evidence-based interventions for opioid-overdose patients, including the ability to prescribe, possess, and administer opioid agonist medication (such as buprenorphine) if recommended by the treating provider. These facilities must also maintain compliance with federal laws and regulations pertaining to opioid agonist treatments, and the administering and dispensing of narcotic drugs. The law also requires that the emergency department affirmatively connect the patient with the appropriate level of care.