Chapter 172
2016 -- S 2356 SUBSTITUTE A AS AMENDED
Enacted 06/28/2016

A N   A C T
RELATING TO HEALTH AND SAFETY -- INSURANCE--MENTAL ILLNESS AND SUBSTANCE ABUSE -- THE ALEXANDER PERRY AND BRANDON GOLDNER ACT

Introduced By: Senators Miller, Jabour, Crowley, Goodwin, and Satchell
Date Introduced: February 10, 2016

It is enacted by the General Assembly as follows:
     SECTION 1. Section 23-17.26-3 of the General Laws in Chapter 23-17.26 entitled
"Comprehensive Discharge Planning" is hereby amended to read as follows:
     23-17.26-3. Comprehensive discharge planning. -- (a) On or before July 1, 2015
January 1, 2017, each hospital and freestanding, emergency-care facility operating in the Sstate of
Rhode Island shall submit to the director a comprehensive discharge plan that includes:
      (1) Evidence of participation in a high-quality, comprehensive discharge-planning and
transitions-improvement project operated by a nonprofit organization in this state; or
     (2) A plan for the provision of comprehensive discharge planning and information to be
shared with patients transitioning from the hospitals hospital's or freestanding, emergency-care
facility's care. Such plan shall contain the adoption of evidence-based practices including, but not
limited to:
     (i) Providing in-hospital education in the hospital or freestanding, emergency-care facility
prior to discharge;
     (ii) Ensuring patient involvement such that, at discharge, patients and caregivers
understand the patient's conditions and medications and have a point of contact for follow-up
questions;
     (iii) With patient consent, attempting to notify the person(s) listed as the patient's
emergency contacts and recovery coach before discharge. If the patient refuses to consent to the
notification of emergency contacts, such refusal shall be noted in the patient's medical record;
     (iii)(iv) Attempting to identify patients' primary care providers and assisting with
scheduling post-hospital post-discharge follow-up appointments prior to patient discharge;
     (iv)(v) Expanding the transmission of the department of health's continuity-of-care form,
or successor program, to include primary care providers' receipt of information at patient
discharge when the primary care provider is identified by the patient; and
     (v)(vi) Coordinating and improving communication with outpatient providers.
     (3) The discharge plan and transition process shall also be made include recovery
planning tools for patients with opioid and other substance use disorders substance-use disorders,
opioid overdoses, and chronic addiction, which plan and transition process shall include the
elements contained in subsections (a)(1) or (a)(2) of this section, as applicable. In addition, such
discharge plan and transition process shall also include:
     (i) Assistance, with patient consent, in securing at least one follow-up appointment for
the patient within seven (7) days of discharge, as clinically appropriate: (A) With a facility
licensed by the department of behavioral healthcare, developmental disabilities and hospitals to
provide treatment of substance use disorders; (B) With a certified recovery coach; (C) With a
licensed clinician with expertise in the treatment of substance use disorders; or (D) With a Rhode
Island licensed hospital with a designated program for the treatment of substance use disorders.
The patient shall be informed of said appointment prior to the patient being discharged from the
hospital;
     (ii) In the absence of a scheduled follow-up appointment pursuant to subsection (a)(3)(i),
every reasonable effort shall be made to contact the patient within thirty (30) days post-discharge
to provide the patient with a referral and other such assistance as the patient needs to obtain a
follow-up appointment; and
     (iii) That the patient receives information about the real-time availability of appropriate
in-patient and out-patient services in Rhode Island.
     (i) That, with patient consent, each patient presenting to a hospital or freestanding,
emergency-care facility with indication of a substance-use disorder, opioid overdose, or chronic
addiction shall receive a substance-abuse evaluation, in accordance with the standards in
subsection (a)(4)(ii), before discharge. Prior to the dissemination of the standards in subsection
(a)(4)(ii), with patient consent, each patient presenting to a hospital or freestanding, emergency-
care facility with indication of a substance-use disorder, opioid overdose, or chronic addiction
shall receive a substance-abuse evaluation, in accordance with best practices standards, before
discharge;
     (ii) That if, after the completion of a substance-abuse evaluation, in accordance with the
standards in subsection (a)(4)(ii), the clinically appropriate inpatient and outpatient services for
the treatment of substance-use disorders, opioid overdose, or chronic addiction contained in
subsection (a)(3)(iv) are not immediately available, the hospital or freestanding, emergency-care
facility shall provide medically necessary and appropriate services with patient consent, until the
appropriate transfer of care is completed;
     (iii) That, with patient consent, pursuant to 21 C.F.R. ยง1306.07, a physician in a hospital
or freestanding, emergency-care facility, who is not specifically registered to conduct a narcotic
treatment program, may administer narcotic drugs, including buprenorphine, to a person for the
purpose of relieving acute, opioid-withdrawal symptoms, when necessary, while arrangements
are being made for referral for treatment. Not more than one day's medication may be
administered to the person or for the person's use at one time. Such emergency treatment may be
carried out for not more than three (3) days and may not be renewed or extended;
     (iv) That each patient presenting to a hospital or freestanding, emergency-care facility
with indication of a substance-use disorder, opioid overdose, or chronic addiction, shall receive
information, made available to the hospital or freestanding, emergency-care facility in accordance
with subsection (a)(4)(v), about the availability of clinically appropriate inpatient and outpatient
services for the treatment of substance-use disorders, opioid overdose, or chronic addiction,
including:
     (A) Detoxification;
     (B) Stabilization;
     (C) Medication-assisted treatment or medication-assisted maintenance services, including
methadone, buprenorphine, naltrexone, or other clinically appropriate medications;
     (D) Inpatient and residential treatment;
     (E) Licensed clinicians with expertise in the treatment of substance-use disorders, opioid
overdoses, and chronic addiction;
     (F) Certified recovery coaches; and
     (v) That, when the real-time patient services database outlined in subsection (a)(4)(vi)
becomes available, each patient shall receive real-time information from the hospital or
freestanding, emergency-care facility about the availability of clinically appropriate inpatient and
outpatient services.
     (4) On or before November 1, 2014 January 1, 2017, the director of the department of
health, shall develop and disseminate to all hospitals, health care clinics, urgent care centers, and
emergency room diversion facilities a model discharge plan and transition process for patients
with opioid and other substance use disorders. This model plan may be used as a guide, but may
be amended and modified to meet the specific needs of each hospital, health care clinic, urgent
care center and emergency room diversion facility. with the director of the department of
behavioral healthcare, developmental disabilities and hospitals, shall:
     (i) Develop and disseminate, to all hospitals and freestanding, emergency-care facilities, a
regulatory standard for the early introduction of a recovery coach during the pre-admission and/or
admission process for patients with substance-use disorders, opioid overdose, or chronic
addiction;
     (ii) Develop and disseminate, to all hospitals and freestanding, emergency-care facilities,
substance-abuse evaluation standards for patients with substance-use disorders, opioid overdose,
or chronic addiction;
     (iii) Develop and disseminate, to all hospitals and freestanding, emergency-care facilities,
pre-admission, admission, and discharge regulatory standards, a recovery plan, and voluntary
transition process for patients with substance-use disorders, opioid overdose, or chronic addiction.
Recommendations from the 2015 Rhode Island governor's overdose prevention and intervention
task force strategic plan may be incorporated into the standards as a guide, but may be amended
and modified to meet the specific needs of each hospital and freestanding, emergency-care
facility;
     (iv) Develop and disseminate best practices standards for health care clinics, urgent-care
centers, and emergency-diversion facilities regarding protocols for patient screening, transfer, and
referral to clinically appropriate inpatient and outpatient services contained in subsection
(a)(3)(iv);
     (v) Develop regulations for patients presenting to hospitals and freestanding, emergency-
care facilities with indication of a substance-use disorder, opioid overdose, or chronic addiction to
ensure prompt, voluntary access to clinically appropriate inpatient and outpatient services
contained in subsection (a)(3)(iv);
     (vi) Develop a strategy to assess, create, implement, and maintain a database of real-time
availability of clinically appropriate inpatient and outpatient services contained in subsection
(a)(3)(iv) of this section on or before January 1, 2018.
     SECTION 2. Section 27-38.2-1 of the General Laws in Chapter 27-38.2 entitled
"Insurance Coverage for Mental Illness and Substance Abuse" is hereby amended to read as
follows:
     27-38.2-1. Coverage for the treatment of mental health and substance use disorders..
-- (a) A group health plan and an individual or group health insurance plan shall provide coverage
for the treatment of mental health and substance-use disorders under the same terms and
conditions as that coverage is provided for other illnesses and diseases.
     (b) Coverage for the treatment of mental health and substance-use disorders shall not
impose any annual or lifetime dollar limitation.
     (c) Financial requirements and quantitative treatment limitations on coverage for the
treatment of mental health and substance-use disorders shall be no more restrictive than the
predominant financial requirements applied to substantially all coverage for medical conditions in
each treatment classification.
     (d) Coverage shall not impose non-quantitative treatment limitations for the treatment of
mental health and substance-use disorders unless the processes, strategies, evidentiary standards,
or other factors used in applying the non-quantitative treatment limitation, as written and in
operation, are comparable to, and are applied no more stringently than, the processes, strategies,
evidentiary standards, or other factors used in applying the limitation with respect to
medical/surgical benefits in the classification.
     (e) The following classifications shall be used to apply the coverage requirements of this
chapter: (1) Inpatient, in-network; (2) Inpatient, out-of-network; (3) Outpatient, in-network; (4)
Outpatient, out-of-network; (5) Emergency care; and (6) Prescription drugs.
     (f) Medication-assisted therapy including methadone, treatment or medication-assisted
maintenance services of substance-use disorders, opioid overdoses, and chronic addiction,
including methadone, buprenorphine, naltrexone, or other clinically appropriate medications,
maintenance services, for the treatment of substance-use disorders, opioid overdoses, and chronic
addiction is included within the appropriate classification based on the site of the service.
     (g) Payors shall rely upon the criteria of the American Society of Addiction Medicine
when developing coverage for levels of care for substance-use disorder treatment.
     SECTION 3. This act shall take effect upon passage.
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LC004564/SUB A/3
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