2023 -- S 0027
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LC000286
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S T A T E O F R H O D E I S L A N D
IN GENERAL ASSEMBLY
JANUARY SESSION, A.D. 2023
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A N A C T
RELATING TO HEALTH AND SAFETY -- COMPREHENSIVE DISCHA RGE PLANNING
Introduced By: Senators Miller, Valverde, Pearson, Goodwin, Lawson, and DiMario
Date Introduced: January 19, 2023
Referred To: Senate Health & Human Services
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 1
"Comprehensive Discharge Planning" is hereby amended to read as follows: 2
23-17.26-3. Comprehensive discharge planning. 3
(a) On or before January 1, 2017, each hospital and freestanding emergency-care facility 4
operating in the state of Rhode Island shall submit to the director a comprehensive discharge plan 5
that includes: 6
(1) Evidence of participation in a high-quality, comprehensive discharge-planning and 7
transitions-improvement project operated by a nonprofit organization in this state; or 8
(2) A plan for the provision of comprehensive discharge planning and information to be 9
shared with patients transitioning from the hospital’s or freestanding emergency-care facility’s 10
care. Such plan shall contain the adoption of evidence-based practices including, but not limited to: 11
(i) Providing education in the hospital or freestanding emergency-care facility prior to 12
discharge; 13
(ii) Ensuring patient involvement such that, at discharge, patients and caregivers 14
understand the patient’s conditions and medications and have a point of contact for follow-up 15
questions; 16
(iii) Encouraging notification of the person(s) listed as the patient’s emergency contacts 17
and certified peer recovery specialist to the extent permitted by lawful patient consent or applicable 18
law, including, but not limited to, the Federal Health Insurance Portability and Accountability Act 19
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of 1996, as amended, and 42 C.F.R. Part 2, as amended. The policy shall also require all attempts 1
at notification to be noted in the patient’s medical record; 2
(iv) Attempting to identify patients’ primary care providers and assisting with scheduling 3
post-discharge follow-up appointments prior to patient discharge; 4
(v) Expanding the transmission of the department of health’s continuity-of-care form, or 5
successor program, to include primary care providers’ receipt of information at patient discharge 6
when the primary care provider is identified by the patient; and 7
(vi) Coordinating and improving communication with outpatient providers. 8
(3) The discharge plan and transition process shall include recovery planning tools for 9
patients with substance use disorders, opioid overdoses, and chronic addiction, which plan and 10
transition process shall include the elements contained in subsection (a)(1) or (a)(2), as applicable. 11
In addition, such discharge plan and transition process shall also include: 12
(i) That, with patient consent, each patient presenting to a hospital or freestanding 13
emergency-care facility with indication of a substance use disorder, opioid overdose, or chronic 14
addiction shall receive a substance use evaluation, in accordance with the standards in subsection 15
(a)(4)(ii), before discharge. Prior to the dissemination of the standards in subsection (a)(4)(ii), with 16
patient consent, each patient presenting to a hospital or freestanding emergency-care facility with 17
indication of a substance use disorder, opioid overdose, or chronic addiction shall receive a 18
substance use evaluation, in accordance with best practices standards, before discharge; 19
(ii) That if, after the completion of a substance use evaluation, in accordance with the 20
standards in subsection (a)(4)(ii), the clinically appropriate inpatient and outpatient services for the 21
treatment of substance use disorders, opioid overdose, or chronic addiction contained in subsection 22
(a)(3)(iv) are not immediately available, the hospital or freestanding emergency-care facility shall 23
provide medically necessary and appropriate services with patient consent, until the appropriate 24
transfer of care is completed; 25
(iii) That, with patient consent, pursuant to 21 C.F.R. § 1306.07, a physician in a hospital 26
or freestanding emergency-care facility, who is not specifically registered to conduct a narcotic 27
treatment program, may administer narcotic drugs, including buprenorphine, to a person for the 28
purpose of relieving acute, opioid-withdrawal symptoms, when necessary, while arrangements are 29
being made for referral for treatment. Not more than one day’s medication may be administered to 30
the person or for the person’s use at one time. Such emergency treatment may be carried out for 31
not more than three (3) days and may not be renewed or extended; 32
(iv) That each patient presenting to a hospital or freestanding emergency-care facility with 33
indication of a substance use disorder, opioid overdose, or chronic addiction, shall receive 34
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information, made available to the hospital or freestanding emergency-care facility in accordance 1
with subsection (a)(4)(v), about the availability of clinically appropriate inpatient and outpatient 2
services for the treatment of mental health disorders, including substance use disorders, opioid 3
overdose, or chronic addiction, including: 4
(A) Detoxification; 5
(B) Stabilization; 6
(C) Medication-assisted treatment or medication-assisted maintenance services, including 7
methadone, buprenorphine, naltrexone, or other clinically appropriate medications; 8
(D) Outpatient, Inpatient inpatient and residential treatment; 9
(E) Licensed clinicians with expertise in the treatment of substance use disorders, opioid 10
overdoses, and chronic addiction; and 11
(F) Certified peer recovery specialists; and. 12
(v) That, when the real-time patient-services database outlined in subsection (a)(4)(vi) 13
becomes available, each patient shall receive real-time information from the hospital or 14
freestanding emergency-care facility about the availability of clinically appropriate inpatient and 15
outpatient services. 16
(4) On or before January 1, 2017, the director of the department of health, with the director 17
of the department of behavioral healthcare, developmental disabilities and hospitals, shall: 18
(i) Develop and disseminate, to all hospitals and freestanding emergency-care facilities, a 19
regulatory standard for the early introduction of a certified peer recovery specialist during the pre-20
admission and/or admission process for patients with substance use disorders, opioid overdose, or 21
chronic addiction; 22
(ii) Develop and disseminate, to all hospitals and freestanding emergency-care facilities, 23
substance use evaluation standards for patients with substance use disorders, opioid overdose, or 24
chronic addiction; 25
(iii) Develop and disseminate, to all hospitals and freestanding emergency-care facilities, 26
pre-admission, admission, and discharge regulatory standards, a recovery plan, and voluntary 27
transition process for patients with substance use disorders, opioid overdose, or chronic addiction. 28
Recommendations from the 2015 Rhode Island governor’s overdose prevention and intervention 29
task force strategic plan may be incorporated into the standards as a guide, but may be amended 30
and modified to meet the specific needs of each hospital and freestanding emergency-care facility; 31
(iv) Develop and disseminate best practices standards for healthcare clinics, urgent-care 32
centers, and emergency-diversion facilities regarding protocols for patient screening, transfer, and 33
referral to clinically appropriate inpatient and outpatient services contained in subsection (a)(3)(iv); 34
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(v) Develop regulations for patients presenting to hospitals and freestanding emergency-1
care facilities with indication of a substance use disorder, opioid overdose, or chronic addiction to 2
ensure prompt, voluntary access to clinically appropriate inpatient and outpatient services 3
contained in subsection (a)(3)(iv); 4
(vi) Develop a strategy to assess, create, implement, and maintain a database of real-time 5
availability of clinically appropriate inpatient and outpatient services contained in subsection 6
(a)(3)(iv) of this section on or before January 1, 2018. 7
(b) Nothing contained in this chapter shall be construed to limit the permitted disclosure of 8
confidential healthcare information and communications permitted in § 5-37.3-4(b)(4)(i) of the 9
confidentiality of health care communications act. 10
(c) On or before September 1, 2017, each hospital and freestanding emergency-care facility 11
operating in the state of Rhode Island shall submit to the director a discharge plan and transition 12
process that shall include provisions for patients with a primary diagnosis of a mental health 13
disorder without a co-occurring substance use disorder. 14
(d) On or before January 1, 2018, the director of the department of health, with the director 15
of the department of behavioral healthcare, developmental disabilities and hospitals, shall develop 16
and disseminate mental health best practices standards for healthcare clinics, urgent care centers, 17
and emergency diversion facilities regarding protocols for patient screening, transfer, and referral 18
to clinically appropriate inpatient and outpatient services. The best practice standards shall include 19
information and strategies to facilitate clinically appropriate prompt transfers and referrals from 20
hospitals and freestanding emergency-care facilities to less intensive settings. 21
(e) The director of the department of health, with the director of the department of 22
behavioral healthcare, developmental disabilities and hospitals, shall utilize the real-time database 23
created under § 23-17.26-3(a)(4)(vi), and develop and implement a plan to ensure that patients with 24
mental health disorders, including substance use disorders, who are in need of, and agree to, 25
clinically appropriate and medically necessary residential, inpatient, or outpatient services are 26
discharged from hospitals and freestanding emergency-care facilities into such settings as 27
expeditiously as possible. 28
(f) On or before March l, 2027, the senate and house committees on health and human 29
services and/or any other committee deemed appropriate by the president of the senate and the 30
speaker of the house of representatives shall conduct a hearing on the impact of subsection (e) of 31
this section to include presentations from payors and providers, and other stakeholders at the 32
discretion of the committee chairs. 33
SECTION 2. Chapter 23-17.26 of the General Laws entitled "Comprehensive Discharge 34
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Planning" is hereby amended by adding thereto the following section: 1
23-17.26-5. Comprehensive patient consent form. 2
Each hospital and freestanding emergency-care facility shall incorporate patient consent 3
for certified peer recovery specialist services into a comprehensive patient consent form. Consent 4
for certified peer recovery services shall be contained in its own discrete section of the 5
comprehensive patient consent form. This section shall be implemented no later than January 1, 6
2024. 7
SECTION 3. Section 27-38.2-1 of the General Laws in Chapter 27-38.2 entitled "Insurance 8
Coverage for Mental Illness and Substance Abuse" is hereby amended to read as follows: 9
27-38.2-1. Coverage for treatment of mental health and substance use disorders. 10
Coverage for treatment of mental health disorders, including substance use disorders. 11
(a) A group health plan and an individual or group health insurance plan, and any contract 12
between the Rhode Island Medicaid program and any health insurance carrier, as defined under 13
chapters 18, 19, 20, and 41 of title 27, shall provide coverage for the treatment of mental health and 14
disorders, including substance use disorders under the same terms and conditions as that coverage 15
is provided for other illnesses and diseases. 16
(b) Coverage for the treatment of mental health and disorders, including substance use 17
disorders shall not impose any annual or lifetime dollar limitation. 18
(c) Financial requirements and quantitative treatment limitations on coverage for the 19
treatment of mental health and disorders, including substance use disorders shall be no more 20
restrictive than the predominant financial requirements applied to substantially all coverage for 21
medical conditions in each treatment classification. 22
(d) Coverage shall not impose be subject to non-quantitative treatment limitations for the 23
treatment of mental health and disorders, including substance use disorders unless the processes, 24
strategies, evidentiary standards, or other factors used in applying the non-quantitative treatment 25
limitation, as written and in operation, are comparable to, and are applied no more stringently than, 26
the processes, strategies, evidentiary standards, or other factors used in applying the limitation with 27
respect to medical/surgical benefits in the classification. 28
(e) The following classifications shall be used to apply the coverage requirements of this 29
chapter: (1) Inpatient, in-network; (2) Inpatient, out-of-network; (3) Outpatient, in-network; (4) 30
Outpatient, out-of-network; (5) Emergency care; and (6) Prescription drugs. 31
(f) Medication-assisted treatment or medication-assisted maintenance services of substance 32
use disorders, opioid overdoses, and chronic addiction, including methadone, buprenorphine, 33
naltrexone, or other clinically appropriate medications, is included within the appropriate 34
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classification based on the site of the service. 1
(g) Payors shall rely upon the criteria of the American Society of Addiction Medicine when 2
developing coverage for levels of care and determining placements for substance use disorder 3
treatment. 4
(h) Patients with substance use disorders shall have access to evidence-based, non-opioid 5
treatment for pain, therefore coverage shall apply to medically necessary chiropractic care and 6
osteopathic manipulative treatment performed by an individual licensed under § 5-37-2. 7
(i) Parity of cost-sharing requirements. Regardless of the professional license of the 8
provider of care, if that care is consistent with the provider’s scope of practice and the health plan’s 9
credentialing and contracting provisions, cost-sharing for behavioral health counseling visits and 10
medication maintenance visits shall be consistent with the cost-sharing applied to primary care 11
office visits. 12
(j) Consistent with coverage for medical and surgical services, a health plan as defined in 13
subsection (a) of this section shall cover clinically appropriate and medically necessary residential 14
or inpatient services, including detoxification and stabilization services, for the treatment of mental 15
health disorders, including substance use disorders, in accordance with this subsection. 16
(1) The health plan shall provide coverage for clinically appropriate and medically 17
necessary residential or inpatient services, including American Society of Addiction Medicine 18
levels of care for residential and inpatient services, and shall not require preauthorization prior to a 19
patient obtaining such services, provided that the facility shall provide the health plan notification 20
of admission, proof that an assessment was conducted based upon the criteria of the American 21
Society of Addiction Medicine or after an appropriate psychiatric assessment for mental health 22
disorders, that residential or inpatient services is the most appropriate and least restrictive level of 23
care necessary, the initial treatment plan, and estimated length of stay within forty-eight hours (48) 24
of admission. 25
(2) Notwithstanding § 27-38.2-3, coverage provided under this subsection shall not be 26
subject to concurrent utilization review during the first twenty-eight (28) days of the residential or 27
inpatient admission provided that the facility notifies the health plan as provided in subsection (j)(1) 28
of this section. The facility shall perform daily clinical review of the patient, including consultation 29
with the health plan at, or just prior to, the fourteenth day of treatment to ensure that the facility 30
determined that the residential or inpatient treatment was clinically appropriate and medically 31
necessary for the patient using an assessment based upon the criteria of the American Society of 32
Addiction Medicine or after an appropriate psychiatric assessment for mental health disorders. 33
(3) Prior to discharge from residential or inpatient services, the facility shall provide the 34
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patient and the health plan with a written discharge plan which shall describe arrangements for 1
additional services needed following discharge from the residential or inpatient facility as 2
determined using an assessment based upon the criteria of the American Society of Addiction 3
Medicine or after an appropriate psychiatric assessment for mental health disorders. Prior to 4
discharge, the facility shall indicate to the health plan whether services included in the discharge 5
plan are secured or determined to be reasonably available. The health plan may conduct utilization 6
review procedures, in consultation with the patient’s treating clinician, regarding the discharge plan 7
and continuation of care. 8
(4) Any utilization review of treatment provided under this subsection may include a 9
review of all services provided during such residential or inpatient treatment, including all services 10
provided during the first twenty-eight (28) days of such residential or inpatient treatment. Provided, 11
however, the health plan shall only deny coverage for any portion of the initial twenty-eight (28) 12
days of residential or inpatient treatment on the basis that such treatment was not medically 13
necessary if such residential or inpatient treatment was contrary to the assessment based upon the 14
criteria of the American Society of Addiction Medicine or after an appropriate psychiatric 15
assessment for mental health disorders. A patient shall not have any financial obligation to the 16
facility for any treatment under this subsection other than any copayment, coinsurance, or 17
deductible otherwise required under the policy. 18
(5) This subsection shall apply only to covered services delivered within the health plan’s 19
provider network. 20
(6) Nothing herein prohibits the health plan from conducting quality of care reviews. 21
(k) No health plan as defined in subsection (a) of this section shall refuse to cover treatment 22
for mental health disorders, including substance use disorders, regardless of the level of care, that 23
such health plan is required to cover pursuant to this section solely because such treatment is 24
ordered by a court of competent jurisdiction or by a government operated diversion program. 25
(l) On or before March l, 2027, the senate and house committees on health and human 26
services and/or any other committee deemed appropriate by the president of the senate and the 27
speaker of the house of representatives shall conduct a hearing on the impact of subsections (j) and 28
(k) of this section to include presentations from payors and providers, and other stakeholders at the 29
discretion of the committee chairs. 30
SECTION 4. This act shall take effect on January 1, 2024. 31
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EXPLANATION
BY THE LEGISLATIVE COUNCIL
OF
A N A C T
RELATING TO HEALTH AND SAFETY -- COMPREHENSIVE DISCHA RGE PLANNING
***
This act would require a health plan to cover clinically appropriate and medically necessary 1
residential or inpatient services, including detoxification and stabilization services, for the 2
treatment of mental health disorders, including substance use disorders. A health plan shall not 3
require preauthorization prior to a patient obtaining such services provided certain notifications are 4
provided to the health plan within forty-eight hours (48) of admission. This act would also provide 5
that such coverage shall not be subject to concurrent utilization review during the first twenty-eight 6
(28) days of the residential or inpatient admission. 7
This act would take effect on January 1, 2024. 8
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