2013 -- S 0198

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LC00480

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STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2013

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A N A C T

RELATING TO BEHAVIORAL HEALTHCARE, DEVELOPMENTAL DISABILITIES AND

HOSPITALS

     Introduced By: Senators Picard, Miller, and Nesselbush

     Date Introduced: February 06, 2013

     Referred To: Senate Health & Human Services

It is enacted by the General Assembly as follows:

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     SECTION 1. Section 40.1-5-6 of the General Laws in Chapter 40.1-5 entitled "Mental

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Health Law" is hereby amended to read as follows:

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     40.1-5-6. Voluntary admission. -- (a) (1) General. - Any individual of lawful age may

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apply for voluntary admission to any facility provided for by this law seeking care and treatment

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for alleged mental disability. The application shall be in writing, signed by the applicant in the

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presence of at least one witness, who shall attest to the application by placing his or her name and

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address thereon. If the applicant has not yet attained his or her eighteenth (18th) birthday, the

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application shall be signed by him or her and his or her parent, guardian, or next of kin.

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      (2) Admission of children. - Any person who is under the age of eighteen (18) and who

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receives medical benefits funded in whole or in part by either the department of children, youth,

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and families or by the department of human services may be admitted to any facility provided for

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by this chapter seeking care and treatment for alleged mental disability only after an initial mental

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health crisis intervention is completed by a provider that is licensed by the department of

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children, youth and families for emergency services, has proper credentials and is contracted with

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the RIte Care health plan or the state and said provider, after considering alternative services to

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hospitalization with the child, family and other providers, requests prior authorization for the

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admission from a representative of the child and family's insurance company or utilization review

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organization representing the insurance company. To ensure the strongest consideration of

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community-based alternatives to hospitalization, any emergency services system operated by the

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department of children, youth and families, including, but not limited to, a telephone crisis hotline

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shall direct families with children in need of behavioral health crisis evaluation to community-

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based settings unless the hospital emergency services are voluntarily sought by the family or

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child, or is deemed medically necessary by any involved party. If the inpatient hospital admits a

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child without the crisis intervention and prior authorization from the insurance company or

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utilization review organization, the hospital will be paid a rate equivalent to an Administratively

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Necessary Day (AND) for each day that the insurance company or utilization review organization

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representing the insurance company determines that the child did not meet the inpatient level of

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care criteria. The state shall ensure that this provision is included in all publicly financed

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contracts and agreements for behavioral health services. Activities conducted pursuant to this

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section shall be exempt from the provisions of section 23-17.12, but shall be subject to the

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provisions of subsection (b) of this section.

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      (3) The department of human services shall develop regulations for emergency

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admissions, that would allow the admitting hospital to maintain their compliance with the

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provisions of the act, while meeting the need of the child.

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      (b) Period of treatment. - If it is determined that the applicant is in need of care and

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treatment for mental disability and no suitable alternatives to admission are available, he or she

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shall be admitted for a period not to exceed thirty (30) days. Successive applications for

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continued voluntary status may be made for successive periods not to exceed ninety (90) days

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each, so long as care and treatment is deemed necessary and documented in accordance with the

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requirements of this chapter, and no suitable alternatives to admission are available.

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      (c) Discharge.

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      (1) A voluntary patient shall be discharged no later than the end of the business day

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following of his or her presenting a written notice of his or her intent to leave the facility to the

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medical official in charge or the medical official designated by him or her, unless that official or

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another qualified person from the facility files an application for the patient's civil court

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certification pursuant to section 40.1-5-8. The notice shall be on a form prescribed by the director

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and made available to all patients at all times. If a decision to file an application for civil court

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certification is made, the patient concerned and his or her legal guardian(s), if any, shall receive

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immediately, but in no event later than twelve (12) hours from the making of the decision, notice

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of the intention from the official in charge of the facility, or his or her designee, and the patient

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may, in the discretion of the official, be detained for an additional period not to exceed two (2)

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business days, pending the filing and setting down for hearing of the application under section

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40.1-5-8.

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      (2) A voluntary patient who gives notice of his or her intention or desire to leave the

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facility may at any time during the period of his or her hospitalization prior to any certification

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pursuant to section 40.1-5-8, following the giving of the notice, submit a written communication

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withdrawing the notice, whereby his or her voluntary status shall be considered to continue

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unchanged until the expiration of thirty (30) or ninety (90) days as provided in subsection (b). In

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the case of an individual under eighteen (18) years of age, the notice or withdrawal of notice may

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be given by either of the persons who made the application for his or her admission, or by a

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person of equal or closer relationship to the patient, who shall, as well, receive notice from the

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official in charge indicating a decision to present an application for civil court certification. The

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official may in his or her discretion refuse to discharge the patient upon notice given by any

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person other than the person who made the application, and in the event of such a refusal the

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person giving notice may apply to a justice of the family court for release of the patient.

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      (d) Examination at facility. - The medical official in charge of a facility shall ensure that

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all voluntary patients receive preliminary physical and psychiatric examinations within twenty-

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four (24) hours of admission. Furthermore, a complete psychiatric examination shall be

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conducted to determine whether the person qualifies for care and treatment under the provisions

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of this chapter. The examination shall begin within forty-eight (48) hours of admission and shall

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be concluded as soon as practicable, but in no case shall extend beyond five (5) days. The

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examination shall include an investigation with the prospective patient of (1) what alternatives for

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admission are available and (2) why those alternatives are not suitable. The alternatives for

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admission investigated and reasons for unsuitability, if any, shall be recorded on the patient's

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record. If it is determined that the patient does not belong to the voluntary class in that a suitable

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alternative to admission is available, or is otherwise ineligible for care and treatment, he or she

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shall be discharged.

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      (e) Rights of voluntary patients. - A voluntary patient shall be informed, in writing, of

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his or her status and rights as a voluntary patient immediately upon his or her admission, and

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again at the time of his or her periodic review(s) as provided in section 40.1-5-10, including his or

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her rights pursuant to section 40.1-5-5(f). Blank forms for purposes of indicating an intention or

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desire to leave a facility shall be available at all times and on and in all wards and segments of a

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facility wherein voluntary patients may reside.

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     SECTION 2. This act shall take effect upon passage.

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LC00480

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N A C T

RELATING TO BEHAVIORAL HEALTHCARE, DEVELOPMENTAL DISABILITIES AND

HOSPITALS

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     This act would require any emergency services system operated by the department of

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children, youth and families to direct families with children in need of behavioral health

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evaluations to community-based settings, unless the hospital emergency services are voluntarily

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sought or is medically necessary.

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     This act would take effect upon passage.

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LC00480

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