2024 -- S 2872

========

LC005694

========

     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2024

____________

A N   A C T

RELATING TO HEALTH AND SAFETY -- COMPREHENSIVE DISCHARGE PLANNING

     

     Introduced By: Senators Miller, Lawson, DiPalma, DiMario, Lauria, and Ujifusa

     Date Introduced: March 22, 2024

     Referred To: Senate Health & Human Services

     It is enacted by the General Assembly as follows:

1

     SECTION 1. Section 23-17.26-3 of the General Laws in Chapter 23-17.26 entitled

2

"Comprehensive Discharge Planning" is hereby amended to read as follows:

3

     23-17.26-3. Comprehensive discharge planning.

4

     (a) On or before January 1, 2017, each hospital and freestanding emergency-care facility

5

operating in the state of Rhode Island shall submit to the director a comprehensive discharge plan

6

that includes:

7

     (1) Evidence of participation in a high-quality, comprehensive discharge-planning and

8

transitions-improvement project operated by a nonprofit organization in this state; or

9

     (2) A plan for the provision of comprehensive discharge planning and information to be

10

shared with patients transitioning from the hospital’s or freestanding emergency-care facility’s

11

care. Such plan shall contain the adoption of evidence-based practices including, but not limited to:

12

     (i) Providing education in the hospital or freestanding emergency-care facility prior to

13

discharge;

14

     (ii) Ensuring patient involvement such that, at discharge, patients and caregivers

15

understand the patient’s conditions and medications and have a point of contact for follow-up

16

questions;

17

     (iii) Encouraging notification of the person(s) listed as the patient’s emergency contacts

18

and certified peer recovery specialist to the extent permitted by lawful patient consent or applicable

19

law, including, but not limited to, the Federal Health Insurance Portability and Accountability Act

 

1

of 1996, as amended, and 42 C.F.R. Part 2, as amended. The policy shall also require all attempts

2

at notification to be noted in the patient’s medical record;

3

     (iv) Attempting to identify patients’ primary care providers and assisting with scheduling

4

post-discharge follow-up appointments prior to patient discharge;

5

     (v) Expanding the transmission of the department of health’s continuity-of-care form, or

6

successor program, to include primary care providers’ receipt of information at patient discharge

7

when the primary care provider is identified by the patient; and

8

     (vi) Coordinating and improving communication with outpatient providers.

9

     (3) The discharge plan and transition process shall include recovery planning tools for

10

patients with substance use disorders, opioid overdoses, and chronic addiction, which plan and

11

transition process shall include the elements contained in subsection (a)(1) or (a)(2), as applicable.

12

In addition, such discharge plan and transition process shall also include:

13

     (i) That, with patient consent, each patient presenting to a hospital or freestanding

14

emergency-care facility with indication of a substance use disorder, opioid overdose, or chronic

15

addiction shall receive a substance use evaluation, in accordance with the standards in subsection

16

(a)(4)(ii), before discharge. Prior to the dissemination of the standards in subsection (a)(4)(ii), with

17

patient consent, each patient presenting to a hospital or freestanding emergency-care facility with

18

indication of a substance use disorder, opioid overdose, or chronic addiction shall receive a

19

substance use evaluation, in accordance with best practices standards, before discharge;

20

     (ii) That if, after the completion of a substance use evaluation, in accordance with the

21

standards in subsection (a)(4)(ii), the clinically appropriate inpatient and outpatient services for the

22

treatment of substance use disorders, opioid overdose, or chronic addiction contained in subsection

23

(a)(3)(iv) are not immediately available, the hospital or freestanding emergency-care facility shall

24

provide medically necessary and appropriate services with patient consent, until the appropriate

25

transfer of care is completed;

26

     (iii) That, with patient consent, pursuant to 21 C.F.R. § 1306.07, a physician in a hospital

27

or freestanding emergency-care facility, who is not specifically registered to conduct a narcotic

28

treatment program, may administer narcotic drugs, including buprenorphine, to a person for the

29

purpose of relieving acute, opioid-withdrawal symptoms, when necessary, while arrangements are

30

being made for referral for treatment. Not more than one day’s medication may be administered to

31

the person or for the person’s use at one time. Such emergency treatment may be carried out for

32

not more than three (3) days and may not be renewed or extended;

33

     (iv) That each patient presenting to a hospital or freestanding emergency-care facility with

34

indication of a substance use disorder, opioid overdose, or chronic addiction, shall receive

 

LC005694 - Page 2 of 8

1

information, made available to the hospital or freestanding emergency-care facility in accordance

2

with subsection (a)(4)(v), about the availability of clinically appropriate inpatient and outpatient

3

services for the treatment of mental health disorders, including substance use disorders, opioid

4

overdose, or chronic addiction, including:

5

     (A) Detoxification;

6

     (B) Stabilization;

7

     (C) Medication-assisted treatment or medication-assisted maintenance services, including

8

methadone, buprenorphine, naltrexone, or other clinically appropriate medications;

9

     (D) Inpatient Outpatient, inpatient and residential treatment;

10

     (E) Licensed clinicians with expertise in the treatment of substance use disorders, opioid

11

overdoses, and chronic addiction; and

12

     (F) Certified peer recovery specialists; and.

13

     (v) That, when the real-time patient-services database outlined in subsection (a)(4)(vi)

14

becomes available, each patient shall receive real-time information from the hospital or

15

freestanding emergency-care facility about the availability of clinically appropriate inpatient and

16

outpatient services.

17

     (4) On or before January 1, 2017, the director of the department of health, with the director

18

of the department of behavioral healthcare, developmental disabilities and hospitals, shall:

19

     (i) Develop and disseminate, to all hospitals and freestanding emergency-care facilities, a

20

regulatory standard for the early introduction of a certified peer recovery specialist during the pre-

21

admission and/or admission process for patients with substance use disorders, opioid overdose, or

22

chronic addiction;

23

     (ii) Develop and disseminate, to all hospitals and freestanding emergency-care facilities,

24

substance use evaluation standards for patients with substance use disorders, opioid overdose, or

25

chronic addiction;

26

     (iii) Develop and disseminate, to all hospitals and freestanding emergency-care facilities,

27

pre-admission, admission, and discharge regulatory standards, a recovery plan, and voluntary

28

transition process for patients with substance use disorders, opioid overdose, or chronic addiction.

29

Recommendations from the 2015 Rhode Island governor’s overdose prevention and intervention

30

task force strategic plan may be incorporated into the standards as a guide, but may be amended

31

and modified to meet the specific needs of each hospital and freestanding emergency-care facility;

32

     (iv) Develop and disseminate best practices standards for healthcare clinics, urgent-care

33

centers, and emergency-diversion facilities regarding protocols for patient screening, transfer, and

34

referral to clinically appropriate inpatient and outpatient services contained in subsection (a)(3)(iv);

 

LC005694 - Page 3 of 8

1

     (v) Develop regulations for patients presenting to hospitals and freestanding emergency-

2

care facilities with indication of a substance use disorder, opioid overdose, or chronic addiction to

3

ensure prompt, voluntary access to clinically appropriate inpatient and outpatient services

4

contained in subsection (a)(3)(iv);

5

     (vi) Develop a strategy to assess, create, implement, and maintain a database of real-time

6

availability of clinically appropriate inpatient and outpatient services contained in subsection

7

(a)(3)(iv) of this section on or before January 1, 2018.

8

     (b) Nothing contained in this chapter shall be construed to limit the permitted disclosure of

9

confidential healthcare information and communications permitted in § 5-37.3-4(b)(4)(i) of the

10

confidentiality of health care communications act.

11

     (c) On or before September 1, 2017, each hospital and freestanding emergency-care facility

12

operating in the state of Rhode Island shall submit to the director a discharge plan and transition

13

process that shall include provisions for patients with a primary diagnosis of a mental health

14

disorder without a co-occurring substance use disorder.

15

     (d) On or before January 1, 2018, the director of the department of health, with the director

16

of the department of behavioral healthcare, developmental disabilities and hospitals, shall develop

17

and disseminate mental health best practices standards for healthcare clinics, urgent care centers,

18

and emergency diversion facilities regarding protocols for patient screening, transfer, and referral

19

to clinically appropriate inpatient and outpatient services. The best practice standards shall include

20

information and strategies to facilitate clinically appropriate prompt transfers and referrals from

21

hospitals and freestanding emergency-care facilities to less intensive settings.

22

     (e) The director of the department of health, with the director of the department of

23

behavioral healthcare, developmental disabilities and hospitals, shall utilize the real-time database

24

created under § 23-17.26-3(a)(4)(vi), and develop and implement a plan to ensure that patients with

25

mental health disorders, including substance use disorders, who are in need of, and agree to,

26

clinically appropriate and medically necessary residential, inpatient, or outpatient services are

27

discharged from hospitals and freestanding emergency-care facilities into such settings as

28

expeditiously as possible.

29

     (f) On or before March l, 2028, the senate and house committees on health and human

30

services and/or any other committee deemed appropriate by the president of the senate and the

31

speaker of the house of representatives shall conduct a hearing on the impact of subsection (e) of

32

this section to include presentations from payors and providers, and other stakeholders at the

33

discretion of the committee chairs.

34

     SECTION 2. Chapter 23-17.26 of the General Laws entitled "Comprehensive Discharge

 

LC005694 - Page 4 of 8

1

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

2

     23-17.26-5. Comprehensive patient consent form.

3

     Each hospital and freestanding emergency-care facility shall incorporate patient consent

4

for certified peer recovery specialist services into a comprehensive patient consent form. Consent

5

for certified peer recovery services shall be contained in its own discrete section of the

6

comprehensive patient consent form. This section shall be implemented no later than January 1,

7

2025.

8

     SECTION 3. Section 27-38.2-1 of the General Laws in Chapter 27-38.2 entitled "Insurance

9

Coverage for Mental Illness and Substance Use Disorders" is hereby amended to read as follows:

10

     27-38.2-1. Coverage for treatment of mental health and substance use disorders

11

Coverage for treatment of mental health disorders, including substance use disorders.

12

     (a) A group health plan and an individual or group health insurance plan, and any contract

13

between the Rhode Island Medicaid program and any health insurance carrier, as defined under

14

chapters 18, 19, 20, and 41 of title 27, shall provide coverage for the treatment of mental health and

15

substance use disorders under the same terms and conditions as that coverage is provided for other

16

illnesses and diseases.

17

     (b) Coverage for the treatment of mental health and disorders, including substance use

18

disorders shall not impose any annual or lifetime dollar limitation.

19

     (c) Financial requirements and quantitative treatment limitations on coverage for the

20

treatment of mental health and disorders, including substance use disorders shall be no more

21

restrictive than the predominant financial requirements applied to substantially all coverage for

22

medical conditions in each treatment classification.

23

     (d) Coverage shall not impose be subject to non-quantitative treatment limitations for the

24

treatment of mental health and disorders, including substance use disorders unless the processes,

25

strategies, evidentiary standards, or other factors used in applying the non-quantitative treatment

26

limitation, as written and in operation, are comparable to, and are applied no more stringently than,

27

the processes, strategies, evidentiary standards, or other factors used in applying the limitation with

28

respect to medical/surgical benefits in the classification.

29

     (e) The following classifications shall be used to apply the coverage requirements of this

30

chapter: (1) Inpatient, in-network; (2) Inpatient, out-of-network; (3) Outpatient, in-network; (4)

31

Outpatient, out-of-network; (5) Emergency care; and (6) Prescription drugs.

32

     (f) Medication-assisted treatment or medication-assisted maintenance services of substance

33

use disorders, opioid overdoses, and chronic addiction, including methadone, buprenorphine,

34

naltrexone, or other clinically appropriate medications, is included within the appropriate

 

LC005694 - Page 5 of 8

1

classification based on the site of the service.

2

     (g) Payors shall rely upon the criteria of the American Society of Addiction Medicine when

3

developing coverage for levels of care and determining placements for substance use disorder

4

treatment.

5

     (h) Patients with substance use disorders shall have access to evidence-based, non-opioid

6

treatment for pain, therefore coverage shall apply to medically necessary chiropractic care and

7

osteopathic manipulative treatment performed by an individual licensed under § 5-37-2.

8

     (i) Parity of cost-sharing requirements. Regardless of the professional license of the

9

provider of care, if that care is consistent with the provider’s scope of practice and the health plan’s

10

credentialing and contracting provisions, cost sharing for behavioral health counseling visits and

11

medication maintenance visits shall be consistent with the cost sharing applied to primary care

12

office visits.

13

     (j) Consistent with coverage for medical and surgical services, a health plan as defined in

14

subsection (a) of this section shall cover clinically appropriate and medically necessary residential

15

or inpatient services, including detoxification and stabilization services, for the treatment of mental

16

health disorders, including substance use disorders, in accordance with this subsection.

17

     (1) The health plan shall provide coverage for clinically appropriate and medically

18

necessary residential or inpatient services, including American Society of Addiction Medicine

19

levels of care for residential and inpatient services, and shall not require preauthorization prior to a

20

patient obtaining such services, provided that the facility shall provide the health plan notification

21

of admission, proof that an assessment was conducted based upon the criteria of the American

22

Society of Addiction Medicine or after an appropriate psychiatric assessment for mental health

23

disorders, that residential or inpatient services is the most appropriate and least restrictive level of

24

care necessary, the initial treatment plan, and estimated length of stay within forty-eight hours (48)

25

of admission.

26

     (2) Notwithstanding § 27-38.2-3, coverage provided under this subsection shall not be

27

subject to concurrent utilization review during the first twenty-eight (28) days of the residential or

28

inpatient admission provided that the facility notifies the health plan as provided in subsection (j)(1)

29

of this section. The facility shall perform daily clinical review of the patient, including consultation

30

with the health plan at, or just prior to, the fourteenth day of treatment to ensure that the facility

31

determined that the residential or inpatient treatment was clinically appropriate and medically

32

necessary for the patient using an assessment based upon the criteria of the American Society of

33

Addiction Medicine or after an appropriate psychiatric assessment for mental health disorders.

34

     (3) Prior to discharge from residential or inpatient services, the facility shall provide the

 

LC005694 - Page 6 of 8

1

patient and the health plan with a written discharge plan which shall describe arrangements for

2

additional services needed following discharge from the residential or inpatient facility as

3

determined using an assessment based upon the criteria of the American Society of Addiction

4

Medicine or after an appropriate psychiatric assessment for mental health disorders. Prior to

5

discharge, the facility shall indicate to the health plan whether services included in the discharge

6

plan are secured or determined to be reasonably available. The health plan may conduct utilization

7

review procedures, in consultation with the patient’s treating clinician, regarding the discharge plan

8

and continuation of care.

9

     (4) Any utilization review of treatment provided under this subsection may include a

10

review of all services provided during such residential or inpatient treatment, including all services

11

provided during the first twenty-eight (28) days of such residential or inpatient treatment. Provided,

12

however, the health plan shall only deny coverage for any portion of the initial twenty-eight (28)

13

days of residential or inpatient treatment on the basis that such treatment was not medically

14

necessary if such residential or inpatient treatment was contrary to the assessment based upon the

15

criteria of the American Society of Addiction Medicine or after an appropriate psychiatric

16

assessment for mental health disorders. A patient shall not have any financial obligation to the

17

facility for any treatment under this subsection other than any copayment, coinsurance, or

18

deductible otherwise required under the policy.

19

     (5) This subsection shall apply only to covered services delivered within the health plan’s

20

provider network.

21

     (6) Nothing herein prohibits the health plan from conducting quality of care reviews.

22

     (k) No health plan as defined in subsection (a) of this section shall refuse to cover treatment

23

for mental health disorders, including substance use disorders, regardless of the level of care, that

24

such health plan is required to cover pursuant to this section solely because such treatment is

25

ordered by a court of competent jurisdiction or by a government operated diversion program.

26

     (l) On or before March l, 2028, the senate and house committees on health and human

27

services and/or any other committee deemed appropriate by the president of the senate and the

28

speaker of the house of representatives shall conduct a hearing on the impact of subsections (j) and

29

(k) of this section to include presentations from payors and providers, and other stakeholders at the

30

discretion of the committee chairs.

31

     SECTION 4. This act shall take effect on January 1, 2025.

========

LC005694

========

 

LC005694 - Page 7 of 8

EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO HEALTH AND SAFETY -- COMPREHENSIVE DISCHARGE PLANNING

***

1

     This act would require a health plan to cover clinically appropriate and medically necessary

2

residential or inpatient services, including detoxification and stabilization services, for the

3

treatment of mental health disorders, including substance use disorders. A health plan shall not

4

require preauthorization prior to a patient obtaining such services provided certain notifications are

5

provided to the health plan within forty-eight hours (48) of admission. This act would also provide

6

that such coverage shall not be subject to concurrent utilization review during the first twenty-eight

7

(28) days of the residential or inpatient admission.

8

     This act would take effect on January 1, 2025.

========

LC005694

========

 

LC005694 - Page 8 of 8