2024 -- S 2872 | |
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LC005694 | |
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STATE OF RHODE ISLAND | |
IN GENERAL ASSEMBLY | |
JANUARY SESSION, A.D. 2024 | |
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A N A C T | |
RELATING TO HEALTH AND SAFETY -- COMPREHENSIVE DISCHARGE PLANNING | |
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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 |
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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 |
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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); |
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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 |
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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 |
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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 |
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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. |
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LC005694 | |
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EXPLANATION | |
BY THE LEGISLATIVE COUNCIL | |
OF | |
A N A C T | |
RELATING TO HEALTH AND SAFETY -- COMPREHENSIVE DISCHARGE PLANNING | |
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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. |
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LC005694 | |
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