2018 -- H 7869

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LC004184

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2018

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A N   A C T

RELATING TO EDUCATION -- SAFE AND SUPPORTIVE SCHOOLS TRUST FUND--

COMBATTING ADDICTION, ACCESSING TREATMENT, REDUCING PRESCRIPTIONS,

AND ENHANCING PREVENTION

     Introduced By: Representative Patricia L. Morgan

     Date Introduced: February 28, 2018

     Referred To: House Finance

     It is enacted by the General Assembly as follows:

     SECTION 1. Title 16 of the General Laws entitled "EDUCATION" is hereby amended

by adding thereto the following chapter:

CHAPTER 110

SAFE AND SUPPORTIVE SCHOOLS TRUST FUND

     16-110-1. Establishment of trust fund.

     (a) There shall be established a safe and supportive schools trust fund for the purpose of

supporting school-based programs that educate children and young persons on addiction,

substance misuse and other risky behaviors, and that identify and support children and young

persons at risk. The fund shall be administered by the department of education which shall use the

fund to provide grants to public elementary, middle, and secondary schools and to public colleges

and universities to support the expansion of educational and intervention programs meeting the

purposes of the fund.

     (b) The fund shall consist of revenue from appropriations or other money appropriated by

the general assembly and specifically designated to be credited to the fund, and revenue from

private sources including, but not limited to, grants, gifts and donations received by the state that

are specifically designated to be credited to the fund. Amounts credited to the fund shall not be

subject to further appropriation and any money remaining in the fund at the end of a fiscal year

shall not revert to the general fund.

     SECTION 2. Chapter 21-28 of the General Laws entitled "Uniform Controlled

Substances Act" is hereby amended by adding thereto the following sections:

     21-28-3.33. Prescriptions -- Definitions.

     (a) "Electronic prescription" means a lawful order from a prescriber for a drug or device

for a specific patient that is generated on an electronic prescribing system that meets federal

requirements for electronic prescriptions for controlled substances, and is transmitted

electronically to a pharmacy designated by the patient without alteration of the prescription

information, except that third-party intermediaries may act as conduits to route the prescription

from the prescriber to the pharmacist; provided, however, that “electronic prescription” shall not

include an order for medication which is dispensed for immediate administration to the ultimate

user. The electronic prescription must be received by the pharmacy on an electronic system that

meets federal requirements for electronic prescriptions. A prescription generated on an electronic

system that is printed out or transmitted via facsimile is not considered an electronic prescription.

     (b) "Licensed mental health professional" means a licensed physician who specializes in

the practice of psychiatry or addiction medicine, a licensed psychologist, a licensed social worker,

a licensed mental health counselor, a licensed psychiatric clinical nurse specialist, a licensed

alcohol and drug counselor or a health care provider whose scope of practice allows such

evaluations pursuant to medical staff policies and practice or other professionals authorized by

the department through regulation.

     (c) As used in this section and unless the context clearly requires otherwise, ''opioid

antagonist'' means naloxone or any other drug approved by the United States Food and Drug

Administration as a competitive narcotic antagonist used in the reversal of overdoses caused by

opioids.

     21-28-3.34. Prescriptions -- Opioid antagonist -- Generally.

     (a) The department of health shall ensure that a statewide standing order is issued to

authorize the dispensing of an opioid antagonist in the state by any licensed pharmacist. The

statewide standing order shall include, but shall not be limited to, written, standardized

procedures or protocols for the dispensing of an opioid antagonist by a licensed pharmacist.

Notwithstanding any general or public law to the contrary, the department, or a physician

designated by the department who is registered to distribute or dispense a controlled substance in

the course of professional practice, may issue a statewide standing order that may be used for a

licensed pharmacist to dispense an opioid antagonist under this section.

     (b) Notwithstanding any general or special law to the contrary, a licensed pharmacist may

dispense an opioid antagonist in accordance with the statewide standing order issued under

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subsection (a) of this section. A pharmacist dispensing an opioid antagonist shall annually report

to the department the number of times the pharmacist dispenses an opioid antagonist. Reports

shall not identify an individual patient, shall be confidential and shall not constitute a public

record. Except for an act of gross negligence or willful misconduct, a pharmacist who, acting in

good faith, dispenses an opioid antagonist shall not be subject to any criminal or civil liability or

any professional disciplinary action by the board of registration in pharmacy related to the use or

administration of an opioid antagonist.

     (c) Except for an act of gross negligence or willful misconduct, the commissioner or

physician who issues the statewide standing order under subsection (a) of this section and any

practitioner who, acting in good faith, directly or through the standing order, prescribes or

dispenses an opioid antagonist shall not be subject to any criminal or civil liability or any

professional disciplinary action.

     (d) A pharmacist filling a prescription for a schedule II substance shall, if requested by

the patient, dispense the prescribed substance in a lesser quantity than indicated on the

prescription. The remaining portion may be filled upon patient request in accordance with federal

law; provided, however, that only the same pharmacy that originally dispensed the lesser quantity

may dispense the remaining portion. Upon an initial partial dispensing of a prescription or a

subsequent dispensing of a remaining portion, the pharmacist or the pharmacist's designee shall

make a notation in the patient's record maintained by the pharmacy, which shall be accessible to

the prescribing practitioner by request, indicating that the prescription was partially filled and the

quantity dispensed.

     (e) Whenever a practitioner, certified nurse practitioner, certified registered nurse

anesthetist, nurse midwife, psychiatric clinical nurse specialist, or physician assistant dispenses a

controlled substance by oral prescription, such individual shall, within a period of not more than

seven (7) days or such shorter period that is required by federal law cause an electronic or written

prescription for the prescribed controlled substance to be delivered to the dispensing pharmacy.

The written prescription may be delivered to the pharmacy in person or by mail, but shall be

postmarked within seven (7) days or such shorter period that is required by federal law.

     (f) A written or electronic prescription for a controlled substance in schedule II shall not

be refilled. Written prescriptions for a controlled substance in schedule II shall be kept in a

separate file.

     (g) Prescribers shall issue an electronic prescription for all controlled substances and

medical devices. The department of public health shall promulgate regulations setting forth

standards for electronic prescriptions.

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     (h) The commissioner, through regulation, shall establish exceptions to the provisions of

this section authorizing the limited use of a written and oral prescription where appropriate. Said

exceptions shall include, but shall not be limited to:

     (1) Prescriptions that are issued by veterinarians;

     (2) Prescriptions that are issued or dispensed in circumstances where electronic

prescribing is not available due to temporary technological or electrical failure;

     (3) A time limited waiver process for practitioners who demonstrate economic hardship,

technological limitations that are not reasonably within the control of the practitioner, or other

exceptional circumstance;

     (4) Instances where it would be impractical for the patient to obtain substances prescribed

by electronic prescription in a timely manner, and such delay would adversely impact the patient's

medical condition;

     (i) All written prescriptions shall be written in ink, indelible pencil or by other means on

a tamper resistant form consistent with federal requirements for Medicaid and signed by the

prescriber.

     21-28-3.35. Monitoring and evaluation.

     (a) The department may provide data from the prescription monitoring program to

practitioners in accordance with this section; provided, however, that practitioners shall be able to

access the data directly through a secure electronic medical record or other similar secure

software or information systems. This data may be used for the purpose of providing medical or

pharmaceutical care to the practitioners' patients only, unless otherwise permitted by this section.

Any such secure software or information system must identify the registered participant on whose

behalf the prescription monitoring program was accessed.

     (b) The department may enter into agreements to permit health care facilities to integrate

secure software or information systems into their electronic medical records for the purpose of

using prescription monitoring program data to perform data analysis, compilation, or

visualization, in order to provide medical or pharmaceutical care to individual patients. Any such

secure software or information system shall be bound to comply with requirements established by

the department to ensure the security and confidentiality of any data transferred.

     (c) After a substance abuse evaluation has been completed treatment may occur within

the acute-care hospital or satellite emergency facility, if appropriate services are available, which

may include induction to medication assisted treatment. If the hospital or satellite emergency

facility is unable to provide such services, the hospital or satellite emergency facility shall refer

the patient to an appropriate and available hospital or treatment provider. Medical necessity for

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further treatment shall be determined by the treating clinician and noted in the patient's medical

record.

     (d) If a patient refuses further treatment after the evaluation is complete, and is otherwise

medically stable, the hospital or satellite emergency facility may initiate discharge proceedings;

provided, however, if the patient is in need of and agrees to further treatment following discharge

pursuant to the substance abuse evaluation, then the hospital shall directly connect the patient

with a community based program prior to discharge or within a reasonable time following

discharge when the community based program is available.

     (e) Upon discharge of a patient who experienced an opiate-related overdose, the acute-

care hospital, satellite emergency facility, or emergency service program shall record the opiate-

related overdose and substance abuse evaluation in the patient's electronic medical record which

shall be directly accessible by other health care providers and facilities consistent with federal and

state privacy requirements through a secure electronic medical record, health information

exchange, or other similar software or information systems for the purposes of:

     (1) Improving ease of access and utilization of such data for treatment or diagnosis;

     (2) Supporting integration of such data within the electronic health records of a health

care provider for purposes of treatment or diagnosis; or

     (3) Allowing health care providers and their vendors to maintain such data for the

purposes of compiling and visualizing such data within the electronic health records of a health

care provider that supports treatment or diagnosis.

     21-28-3.36. Commission to review prescribing procedures for dentists.

     (a) There shall be a commission to review and make recommendations about appropriate

prescribing practices related to the most common oral and maxillofacial surgical procedures,

which shall include the removal of wisdom teeth. The commission shall engage with drug

manufacturers to create a pre-packaged product such as a blister pack or z-pack to be used in

connection with common oral and maxillofacial surgical procedures that will provide patients

with an appropriate, standard post-procedure dosage and quantity of commonly prescribed drugs.

     (b) The commission shall be comprised of: the director of the department of health or

designee, who shall serve as chair, a representative from the Rhode Island Dental Society, and

four (4) persons who shall be appointed by the governor, one of whom shall be an oral surgeon,

one of whom shall be a nurse with expertise in maxillofacial surgical procedures, and two (2) of

whom shall have expertise in pain management.

     (c) The commission shall file its recommendations, including any recommendations for

legislation, with the clerks of the senate and the house of representatives eighteen (18) months

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from the effective date of this section.

     21-28-3.37. Commission to review treatment protocols.

     (a) There shall be a commission to review evidence-based treatment for individuals with

a substance use disorder, mental illness or co-occurring substance use disorder and mental illness.

The commission shall create a taxonomy of licensed behavioral health clinician specialties, which

may be used by insurance carriers to develop a provider network. The commission shall

recommend a process that may be used by carriers to validate a licensed behavioral health

clinician's specialty.

     (b) The commission shall be comprised of: the director of the department of health or

designee, who shall serve as chair; the commissioner of insurance or a designee; the executive

director of the group insurance commission or a designee; and seven (7) persons who shall be

appointed by the director of the department of health; one of whom shall have expertise in the

treatment of individuals with substance use disorders; one of whom shall have expertise in the

treatment of individuals with a mental illness; two (2) of whom shall represent payers; one of

whom shall be a licensed behavioral health clinician; and two (2) of whom shall be family

members of individuals with a substance use disorders or mental illness.

     (c) The commission shall file a report of its findings and recommendations together with

any proposed legislation with the clerks of the senate and the house of representatives one

hundred eighty (180) days from the effective date of this act.

     SECTION 3. Chapter 23-10.1 of the General Laws entitled "Emergency Commitment for

Drug Intoxication" is hereby amended by adding thereto the following sections:

     23-10.1-4.1. Involuntary commitment of substance abusers.

     (a) A person may be committed to the custody of the department by the district court

upon the petition of their spouse or guardian, a relative, the certifying physician, or the

administrator in charge of any approved public treatment facility. The petition shall allege that the

person is a drug or intoxicating substance abuser who habitually lacks self-control as to the use of

intoxicating substances, or that they are incapacitated by the use of a controlled substance, and

that they:

     (1) Have threatened, attempted, or inflicted physical harm on themselves or another and

that unless committed are likely to inflict physical harm on themselves or another; or

     (2) Will continue to suffer abnormal mental, emotional, or physical distress, will continue

to deteriorate in ability to function independently if not treated, and are unable to make a rational

and informed choice as to whether or not to submit to treatment, and as a result, poses a danger to

themselves. Evidence that the person has had numerous short-term, involuntary admissions to a

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treatment facility shall be considered by the court in making a decision pursuant to this chapter.

The petition shall be accompanied by a certificate of a licensed physician who has examined the

person within three (3) days before submission of the petition, unless the person whose

commitment is sought has refused to submit to a medical examination, in which case the fact of

refusal shall be alleged in the petition. The certificate shall set forth the physician's findings in

support of the allegations of the petition.

     (b) Upon filing the petition, the court shall fix a date for a hearing no later than ten (10)

days after the date the petition was filed. A copy of the petition and of the notice of the hearing,

including the date fixed by the court, shall be served on the petitioner, the person whose

commitment is sought, their next-of-kin other than the petitioner, a parent or their legal guardian

if they are a minor, the administrator in charge of the approved public treatment facility to which

they have been committed for emergency care, and any other person the court believes advisable.

A copy of the petition and certificate shall be delivered to each person notified.

     (c) At the hearing the court shall hear all relevant testimony, including, if possible, the

testimony of at least one licensed physician who has examined the person whose commitment is

sought. The person shall be present unless the court believes that their presence is likely to be

injurious to them; in this event the court shall appoint a guardian ad litem to represent them

throughout the proceeding. The court shall examine the person in open court, or if advisable shall

examine the person out of court. If the person has refused to be examined by a licensed physician,

they shall be given an opportunity to be examined by a court-appointed licensed physician. If they

refuse and there is sufficient evidence to believe that the allegations of the petition are true, or if

the court believes that more medical evidence is necessary, the court may make a temporary order

committing them to the department for a period of not more than five (5) days for purposes of a

diagnostic examination.

     (d) If after hearing all relevant evidence, including the results of any diagnostic

examination by the department, the court finds that grounds for involuntary commitment have

been established by clear and convincing proof, it shall make an order of commitment to the

department. It may not order commitment of a person unless it determines that the department is

able to provide adequate and appropriate treatment for them and the treatment is likely to be

beneficial.

     (e) A person committed under this section shall remain in the custody of the department

for treatment for a period of thirty (30) days unless sooner discharged. At the end of the thirty

(30) day period, they shall be discharged automatically unless the department, before the

expiration of the period, obtains a court order for their recommitment upon the grounds set forth

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in subsection (a) of this section for a further period of ninety (90) days unless sooner discharged.

If a person has been committed because they are a drug or intoxicating substance abuser likely to

inflict physical harm on themselves or another, the department shall apply for recommitment if

after examination it is determined that the likelihood still exists.

     (f) A person recommitted under subsection (a) of this section who has not been

discharged by the department before the end of the ninety (90) day period shall be discharged at

the expiration of that period unless the department, before the expiration of the period, obtains a

court order on the grounds set forth in subsection (a) of this section for recommitment for a

further period not to exceed ninety (90) days. If a person has been committed because they are a

drug or intoxicating substance abuser likely to inflict physical harm on themselves or another, the

department shall apply for recommitment if after examination it is determined that the likelihood

still exists. Only two (2) recommitment orders under subsections (e) and (f) of this section shall

be permitted.

     (g) Upon the filing of a petition for recommitment under subsections (e) or (f) of this

section, the court shall fix a date for a hearing no later than ten (10) days after the date the

petition was filed. A copy of the petition and of the notice of the hearing, including the date fixed

by the court, shall be served on the petitioner, the person whose commitment is sought, their next-

of-kin other than the petitioner, the original petitioner under subsection (a) of this section if

different from the petitioner for recommitment, one of their parents or their legal guardian if they

are a minor, and any other person the court believes advisable. At the hearing the court shall

proceed as provided in subsection (c) of this section.

     (h) The department shall provide for adequate and appropriate treatment of a person

committed to its custody. The department may transfer any person committed to its custody from

one approved public treatment facility to another if transfer is medically advisable.

     (i) A person committed to the custody of the department for treatment shall be discharged

at any time before the end of the period for which they have been committed if either of the

following conditions is met:

     (1) In case of a drug or intoxicating substance abuser committed on the grounds of

likelihood of infliction of physical harm upon themselves or another, that they are no longer a

drug or intoxicating substance abuser or the likelihood no longer exists; or

     (2) In case of a drug or intoxicating substance abuser committed on the grounds of the

need of treatment, deterioration, inability to function, or the fact that they are a danger to

themselves, that the deterioration no longer exists, that they are no longer a danger to themselves,

that they are able to function, that further treatment will not be likely to bring about significant

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improvement in the person's condition, or treatment is no longer adequate or appropriate.

     (j) The court shall inform the person whose commitment or recommitment is sought of

their right to contest the application, be represented by counsel at every stage of any proceedings

relating to their commitment and recommitment, and have counsel appointed by the court or

provided by the court if they want the assistance of counsel and are unable to obtain counsel. If

the court believes that the person needs the assistance of counsel, the court shall require, by

appointment if necessary, counsel for them regardless of their wishes. The person whose

commitment or recommitment is sought shall be informed of their right to be examined by a

licensed physician of their choice. If the person is unable to obtain a licensed physician and

requests examination by a physician, the court shall employ a licensed physician.

     (k) If a private treatment facility agrees with the request of a competent patient or their

parent, sibling, adult child, or guardian to accept the patient for treatment, the administrator of the

public treatment facility shall transfer them to the private treatment facility.

     (l) A person committed under this chapter may at any time seek to be discharged from

commitment by writ of habeas corpus.

     (m)(1) Any aggrieved party may appeal to the superior court from a judgment of the

district court by claiming the appeal in writing filed with the clerk within forty-eight (48) hours,

exclusive of Sundays and legal holidays, after the judgment is entered.

     (2) All court actions shall be heard within fourteen (14) days after the appeal and shall

have precedence on the calendar and shall continue to have precedence on the calendar on a day-

to-day basis until the matter is heard.

     23-10.1-7. Standards for treatment facilities -- Inspections -- Furnishing information

to department -- Noncompliance with standards.

     (a) The department shall establish standards for approved treatment facilities that must be

met for a treatment facility to be approved as a public or private treatment facility, and fix the

fees to be charged by the department for the required inspections. The standards may concern

only the health standards to be met and standards of treatment to be afforded patients.

     (b) The department shall periodically inspect approved public and private treatment

facilities at reasonable times and in a reasonable manner.

     (c) The department shall maintain a list of approved public and private treatment

facilities.

     (d) Each approved public and private treatment facility shall file with the department on

request: data, statistics, schedules, and any other information that the department reasonably

requires. An approved public or private treatment facility that without good cause fails to furnish

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any data, statistics, schedules, and any other information as requested, or files fraudulent returns,

shall be removed from the list of approved treatment facilities.

     (e) The department, after holding a hearing, may suspend, revoke, limit, or restrict an

approval, or refuse to grant an approval, for failure to meet its standards.

     SECTION 4. Chapter 23-17 of the General Laws entitled "Licensing of Health Care

Facilities" is hereby amended by adding thereto the following section:

     23-17-64. Licensing of facilities – Inpatient psychiatric, residential or day care

services.

     (a) The department of health (hereinafter referred to as the "department") shall issue for a

term of two (2) years, and may renew for a like term, a license, subject to revocation by it for

cause, to any private or municipal facility or department or unit of any such facility which offers

inpatient psychiatric, residential or day care services, and is represented as providing treatment of

persons who are mentally ill, and which is deemed by it to be responsible and suitable to meet

applicable licensure standards and requirements, set forth in regulations of the department, except

that:

     (1) The department may license those facilities providing care, but not treatment of

persons who are mentally ill, and

     (2) Licensing by the department is not required where a residential or day care treatment

is provided within an institution or facility licensed by the department unless the services are

provided on an involuntary basis. The department may issue a provisional license where a facility

has not previously operated, or is operating but is temporarily unable to meet applicable standards

and requirements. No original license shall be issued to establish or maintain an inpatient facility

subject to licensure under this section, unless there is a determination by the department, in

accordance with its regulations, that there is need for such a facility. The department may grant

the type of license that it deems suitable for the facility, department or unit. The department shall

set reasonable fees for licenses and renewal thereof.

     (b) Each facility, department or unit licensed by the department shall be subject to the

supervision, visitation, and inspection of the department. The department shall establish

regulations to administer licensing standards, and to provide operational standards for the

facilities, departments or units, including, but not limited to, the standards or criteria an applicant

shall meet to demonstrate the need for an original license. In order to be licensed by the

department under this section, a facility shall provide services to state residents with public health

insurance on a non-discriminatory basis. The regulations shall provide that no facility, department

or unit shall discriminate against an individual, qualified within the scope of the individual's

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license, when considering or acting on an application of a licensed independent clinical social

worker for staff membership or clinical privileges. The regulations shall further provide that each

application shall be considered solely on the basis of the applicant's education, training, current

competence and experience. Each facility, department or unit shall establish, in consultation with

the director of the department of human services or, if none, a consulting licensed independent

clinical social worker, the specific standards, criteria and procedures to admit an applicant for

staff membership and clinical privileges. The standards shall be available to the director upon

request.

     (c) The department may conduct surveys and investigations to enforce compliance with

this section and any rule or regulation promulgated under this section. The department may

examine the books and accounts of any facility if it deems such examination necessary for the

purposes of this section. If the department finds upon inspection, or through information in its

possession, that a facility, department or unit licensed by the department is not in compliance

with a requirement established under this section, the department may order the facility,

department or unit to correct such deficiency by providing the facility notice in writing of each

deficiency. The notice shall specify a reasonable time, not to exceed sixty (60) days after receipt

thereof, by which time the facility, department or unit shall remedy or correct each deficiency

cited therein; provided, that, in the case of any deficiency which, in the opinion of the department,

is not capable of correction within sixty (60) days, the department shall require only that the

facility, department or unit submit a written plan for correction for the deficiency in a reasonable

manner. The department may modify any nonconforming plan, upon notice in writing to the

facility. Within seven (7) days of receipt, the affected facility, department or unit may file a

written request with the department for administrative reconsideration of the order or any portion

thereof.

     (d) Nothing in this section shall be construed to prohibit the department from enforcing a

rule, regulation, or corrective action order, administratively or in court, without first affording

formal opportunity to make correction, or to seek administrative reconsideration under this

section, where, in the opinion of the department, the violation of such rule or regulation

jeopardizes the health or safety of patients or the public or seriously limits the capacity of the

facility to provide adequate care, or where the violation of such rule or regulation is the second or

subsequent such violation occurring during a period of twelve (12) full months.

     (e) Failure to remedy or correct a cited deficiency by the date specified in the written

notice or failure to remedy or correct a cited deficiency by the date specified in the written notice

or failure to remedy or correct a cited deficiency by the date specified in a plan for correction, as

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accepted or modified by the department, shall be cause for license revocation or a civil fine

imposed upon the facility. The civil fine shall not exceed one thousand dollars ($1,000) per

deficiency for each day the deficiency continues to exist beyond the date prescribed for

correction. The department may pursue either remedy or both or such other sanction as the

department may impose administratively upon the facility, department or unit. No facility,

department or unit, for which a license is required under subsection (a) of this section, shall

provide inpatient, residential or day care services for the treatment or care of persons who are

mentally ill, unless it has obtained a license under this section. The superior court sitting in equity

shall have jurisdiction, upon petition of the department, to restrain any violation of the provisions

of this section or to take such other action as equity and justice may require. Any person who

violates the provisions of this section shall be subject for the first offense to a fine of not more

than five hundred dollars ($500) and for subsequent offenses by a fine of not more than one

thousand dollars ($1,000), or by imprisonment for not more than two (2) years.

     (f) No patient shall be commercially exploited. No patient shall be photographed,

interviewed or exposed to public view without the express written consent of the patient or of the

patient's legal guardian.

     (g) Notwithstanding the provisions of subsections (a) through (f) of this section,

inclusive, no child care center, family child care home, family child care system, family foster

care or group care facility shall be subject to this section.

     (h) As used in this section, "original license" means a license, including a provisional

license, issued to an inpatient facility not previously licensed; or a license issued to an existing

inpatient facility, in which there has been a change in ownership or location or a change in class

of license or specialized service as provided in regulations of the department.

     SECTION 5. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO EDUCATION -- SAFE AND SUPPORTIVE SCHOOLS TRUST FUND--

COMBATTING ADDICTION, ACCESSING TREATMENT, REDUCING PRESCRIPTIONS,

AND ENHANCING PREVENTION

***

     This act would, through the amendments to several sections of law, govern the treatment

of, and prescription of drugs for, persons with opiate abuse and related issues.

     This act would take effect upon passage.

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