2013 -- S 0835

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LC01866

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STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2013

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S E N A T E R E S O L U T I O N

RESPECTFULLY REQUESTING THE DIRECTOR OF THE DEPARTMENT OF HEALTH

IMPLEMENT THE SPECIAL SENATE COMMISSION ON EMERGENCY DEPARTMENT

DIVERSION RECOMMENDATIONS

     Introduced By: Senators Jabour, Miller, Goldin, Nesselbush, and Crowley

     Date Introduced: April 04, 2013

     Referred To: Senate Health & Human Services

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     WHEREAS, The Special Senate Commission to Study Emergency Department Diversion

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("Commission") convened in 2011, with 19 members representing a variety of stakeholders and

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interests, and developed a series of findings and recommendations to address the overutilization

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of high cost, high levels of non-emergent behavioral health usage that could be appropriately

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treated in alternative settings; and

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     WHEREAS, The Commission found an excess of patients with non-emergent behavioral

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health needs inappropriately utilizing costly, municipal emergency management services (EMS)

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and overutilization of fee-for-service payments in emergency room departments; and

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     WHEREAS, Challenges -- including lack of adequate wrap-around services, lack of

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resources, and high levels of behavioral health systems fragmentation -- could be more cost

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effectively addressed in alternative settings for a continuum of comprehensive, supportive

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services; and

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     WHEREAS, The Commission issued a number of recommendations and, as a result,

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passed legislation in 2012 that amended the existing RI alcohol treatment statute to make it more

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flexible to allow individuals to be transported to alternative community-based settings and to

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authorize evaluations performed by medical staff, other than physicians; and

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     WHEREAS, The Department of Behavioral Healthcare, Developmental Disabilities and

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Hospitals ("Department") issued a report on the feasibility of drafting a Request for Proposal

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("RFP") for the creation of a three year pilot program to deliver, in an alternative setting,

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comprehensive care for this population; and

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     WHEREAS, Rhode Island is a national leader in its effort to move from a fee-for-service

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("ffs") model to alternative payment methods which reduce readmissions, prevent hospital

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acquired conditions, place greater emphasis on primary and preventative care, and other

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improvements that are critical to reducing costs and improving healthcare quality; and

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     WHEREAS, The Commission supported the department in exploring opportunities for

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funding the alternative pilot program and, as a result, a variety of providers have made significant

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financial commitments towards the establishment of the facility; and

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     WHEREAS, The Commission reconvened in February 2013 to move from planning to

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implementation, and the Rhode Island Medicaid Program presented potential opportunities for

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financing under the application for a new comprehensive Medicaid waiver; and

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     WHEREAS, The Rhode Island Executive Office of Health and Human Services

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(EOHHS) is in the process of finalizing its Part II application for the Medicaid Waiver to the

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Federal Centers for Medicare and Medicaid Services (CMS); now, therefore be it

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     RESOLVED, That this Senate of the State of Rhode Island and Providence Plantations

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hereby respectfully requests that the EOHHS include as part of the RI Medicaid Waiver

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Application, a waiver option for Medicaid covered individuals who voluntarily choose a

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medically appropriate rehabilitation alternative to emergency room care and any associated

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emergency room admissions. The rate paid to providers shall not exceed 90% of the DRG that

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has historically been associated with emergency room related admissions for outpatient care for

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the same or related diagnoses. The waiver application shall provide the average number of

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individuals receiving such Medicaid waiver services on any day during that state fiscal year shall

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not exceed twenty (20). The term of the waiver shall not exceed five (5) years and the State shall

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have the option of terminating the waiver at any time during the period of the waiver. Payments

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for such waiver services shall be made from funds appropriated from Medicaid hospital care; and

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be it further

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     RESOLVED, That upon approval by the Centers of Medicare and Medicaid Services

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(CMS), the Department of Health shall: (i) promulgate the necessary regulations to license the

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provider, in accordance with Chapter 23-17; (ii) determine the total amount of allowable

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expenditures based on approved number(s) of episodic care and length of stay in a defined time

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period in order to (iii) issue a Request for Proposals (RFP) to establish a three year pilot program,

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using in kind, donated and federal funding, to provide a medically supervised sobering center

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designed to divert intoxicated persons from hospital emergency departments to a 24-hour central

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facility, providing medical screening, integrated case management services and linkages to a

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comprehensive continuum of care; and, shall provide an annual report of its findings and

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recommendations to the General Assembly and Governor no later than January 31st of each year

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beginning in 2014, and each year thereafter and for a period of three years, shall provide to the

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Governor, the President of the Senate, and the Speaker of the House of Representatives an annual

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report on the outcomes, funding, and recommendations as to whether the pilot program shall be

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continued, terminated or expanded; and be it further

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     RESOLVED, That the Secretary of State be and hereby is authorized and directed to

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transmit duly certified copies of this resolution to the Governor, the Secretary of the Executive

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Office of Health and Human Services, and the Director of the Department of Health.

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LC01866

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