Rhode Island 2023 Regular Session

Rhode Island Senate Bill S0027 Compare Versions

Only one version of the bill is available at this time.

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5	5	2023 -- S 0027
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7	7	LC000286
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9	9	S T A T E O F R H O D E I S L A N D
10	10	IN GENERAL ASSEMBLY
11	11	JANUARY SESSION, A.D. 2023
12	12	____________
13	13
14	14	A N A C T
15	15	RELATING TO HEALTH AND SAFETY -- COMPREHENSIVE DISCHA RGE PLANNING
16	16	Introduced By: Senators Miller, Valverde, Pearson, Goodwin, Lawson, and DiMario
17	17	Date Introduced: January 19, 2023
18	18	Referred To: Senate Health & Human Services
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21	21	It is enacted by the General Assembly as follows:
22	22	SECTION 1. Section 23-17.26-3 of the General Laws in Chapter 23-17.26 entitled 1
23	23	"Comprehensive Discharge Planning" is hereby amended to read as follows: 2
24	24	23-17.26-3. Comprehensive discharge planning. 3
25	25	(a) On or before January 1, 2017, each hospital and freestanding emergency-care facility 4
26	26	operating in the state of Rhode Island shall submit to the director a comprehensive discharge plan 5
27	27	that includes: 6
28	28	(1) Evidence of participation in a high-quality, comprehensive discharge-planning and 7
29	29	transitions-improvement project operated by a nonprofit organization in this state; or 8
30	30	(2) A plan for the provision of comprehensive discharge planning and information to be 9
31	31	shared with patients transitioning from the hospital’s or freestanding emergency-care facility’s 10
32	32	care. Such plan shall contain the adoption of evidence-based practices including, but not limited to: 11
33	33	(i) Providing education in the hospital or freestanding emergency-care facility prior to 12
34	34	discharge; 13
35	35	(ii) Ensuring patient involvement such that, at discharge, patients and caregivers 14
36	36	understand the patient’s conditions and medications and have a point of contact for follow-up 15
37	37	questions; 16
38	38	(iii) Encouraging notification of the person(s) listed as the patient’s emergency contacts 17
39	39	and certified peer recovery specialist to the extent permitted by lawful patient consent or applicable 18
40	40	law, including, but not limited to, the Federal Health Insurance Portability and Accountability Act 19
41	41
42	42
43	43	LC000286 - Page 2 of 8
44	44	of 1996, as amended, and 42 C.F.R. Part 2, as amended. The policy shall also require all attempts 1
45	45	at notification to be noted in the patient’s medical record; 2
46	46	(iv) Attempting to identify patients’ primary care providers and assisting with scheduling 3
47	47	post-discharge follow-up appointments prior to patient discharge; 4
48	48	(v) Expanding the transmission of the department of health’s continuity-of-care form, or 5
49	49	successor program, to include primary care providers’ receipt of information at patient discharge 6
50	50	when the primary care provider is identified by the patient; and 7
51	51	(vi) Coordinating and improving communication with outpatient providers. 8
52	52	(3) The discharge plan and transition process shall include recovery planning tools for 9
53	53	patients with substance use disorders, opioid overdoses, and chronic addiction, which plan and 10
54	54	transition process shall include the elements contained in subsection (a)(1) or (a)(2), as applicable. 11
55	55	In addition, such discharge plan and transition process shall also include: 12
56	56	(i) That, with patient consent, each patient presenting to a hospital or freestanding 13
57	57	emergency-care facility with indication of a substance use disorder, opioid overdose, or chronic 14
58	58	addiction shall receive a substance use evaluation, in accordance with the standards in subsection 15
59	59	(a)(4)(ii), before discharge. Prior to the dissemination of the standards in subsection (a)(4)(ii), with 16
60	60	patient consent, each patient presenting to a hospital or freestanding emergency-care facility with 17
61	61	indication of a substance use disorder, opioid overdose, or chronic addiction shall receive a 18
62	62	substance use evaluation, in accordance with best practices standards, before discharge; 19
63	63	(ii) That if, after the completion of a substance use evaluation, in accordance with the 20
64	64	standards in subsection (a)(4)(ii), the clinically appropriate inpatient and outpatient services for the 21
65	65	treatment of substance use disorders, opioid overdose, or chronic addiction contained in subsection 22
66	66	(a)(3)(iv) are not immediately available, the hospital or freestanding emergency-care facility shall 23
67	67	provide medically necessary and appropriate services with patient consent, until the appropriate 24
68	68	transfer of care is completed; 25
69	69	(iii) That, with patient consent, pursuant to 21 C.F.R. § 1306.07, a physician in a hospital 26
70	70	or freestanding emergency-care facility, who is not specifically registered to conduct a narcotic 27
71	71	treatment program, may administer narcotic drugs, including buprenorphine, to a person for the 28
72	72	purpose of relieving acute, opioid-withdrawal symptoms, when necessary, while arrangements are 29
73	73	being made for referral for treatment. Not more than one day’s medication may be administered to 30
74	74	the person or for the person’s use at one time. Such emergency treatment may be carried out for 31
75	75	not more than three (3) days and may not be renewed or extended; 32
76	76	(iv) That each patient presenting to a hospital or freestanding emergency-care facility with 33
77	77	indication of a substance use disorder, opioid overdose, or chronic addiction, shall receive 34
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81	81	information, made available to the hospital or freestanding emergency-care facility in accordance 1
82	82	with subsection (a)(4)(v), about the availability of clinically appropriate inpatient and outpatient 2
83	83	services for the treatment of mental health disorders, including substance use disorders, opioid 3
84	84	overdose, or chronic addiction, including: 4
85	85	(A) Detoxification; 5
86	86	(B) Stabilization; 6
87	87	(C) Medication-assisted treatment or medication-assisted maintenance services, including 7
88	88	methadone, buprenorphine, naltrexone, or other clinically appropriate medications; 8
89	89	(D) Outpatient, Inpatient inpatient and residential treatment; 9
90	90	(E) Licensed clinicians with expertise in the treatment of substance use disorders, opioid 10
91	91	overdoses, and chronic addiction; and 11
92	92	(F) Certified peer recovery specialists; and. 12
93	93	(v) That, when the real-time patient-services database outlined in subsection (a)(4)(vi) 13
94	94	becomes available, each patient shall receive real-time information from the hospital or 14
95	95	freestanding emergency-care facility about the availability of clinically appropriate inpatient and 15
96	96	outpatient services. 16
97	97	(4) On or before January 1, 2017, the director of the department of health, with the director 17
98	98	of the department of behavioral healthcare, developmental disabilities and hospitals, shall: 18
99	99	(i) Develop and disseminate, to all hospitals and freestanding emergency-care facilities, a 19
100	100	regulatory standard for the early introduction of a certified peer recovery specialist during the pre-20
101	101	admission and/or admission process for patients with substance use disorders, opioid overdose, or 21
102	102	chronic addiction; 22
103	103	(ii) Develop and disseminate, to all hospitals and freestanding emergency-care facilities, 23
104	104	substance use evaluation standards for patients with substance use disorders, opioid overdose, or 24
105	105	chronic addiction; 25
106	106	(iii) Develop and disseminate, to all hospitals and freestanding emergency-care facilities, 26
107	107	pre-admission, admission, and discharge regulatory standards, a recovery plan, and voluntary 27
108	108	transition process for patients with substance use disorders, opioid overdose, or chronic addiction. 28
109	109	Recommendations from the 2015 Rhode Island governor’s overdose prevention and intervention 29
110	110	task force strategic plan may be incorporated into the standards as a guide, but may be amended 30
111	111	and modified to meet the specific needs of each hospital and freestanding emergency-care facility; 31
112	112	(iv) Develop and disseminate best practices standards for healthcare clinics, urgent-care 32
113	113	centers, and emergency-diversion facilities regarding protocols for patient screening, transfer, and 33
114	114	referral to clinically appropriate inpatient and outpatient services contained in subsection (a)(3)(iv); 34
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118	118	(v) Develop regulations for patients presenting to hospitals and freestanding emergency-1
119	119	care facilities with indication of a substance use disorder, opioid overdose, or chronic addiction to 2
120	120	ensure prompt, voluntary access to clinically appropriate inpatient and outpatient services 3
121	121	contained in subsection (a)(3)(iv); 4
122	122	(vi) Develop a strategy to assess, create, implement, and maintain a database of real-time 5
123	123	availability of clinically appropriate inpatient and outpatient services contained in subsection 6
124	124	(a)(3)(iv) of this section on or before January 1, 2018. 7
125	125	(b) Nothing contained in this chapter shall be construed to limit the permitted disclosure of 8
126	126	confidential healthcare information and communications permitted in § 5-37.3-4(b)(4)(i) of the 9
127	127	confidentiality of health care communications act. 10
128	128	(c) On or before September 1, 2017, each hospital and freestanding emergency-care facility 11
129	129	operating in the state of Rhode Island shall submit to the director a discharge plan and transition 12
130	130	process that shall include provisions for patients with a primary diagnosis of a mental health 13
131	131	disorder without a co-occurring substance use disorder. 14
132	132	(d) On or before January 1, 2018, the director of the department of health, with the director 15
133	133	of the department of behavioral healthcare, developmental disabilities and hospitals, shall develop 16
134	134	and disseminate mental health best practices standards for healthcare clinics, urgent care centers, 17
135	135	and emergency diversion facilities regarding protocols for patient screening, transfer, and referral 18
136	136	to clinically appropriate inpatient and outpatient services. The best practice standards shall include 19
137	137	information and strategies to facilitate clinically appropriate prompt transfers and referrals from 20
138	138	hospitals and freestanding emergency-care facilities to less intensive settings. 21
139	139	(e) The director of the department of health, with the director of the department of 22
140	140	behavioral healthcare, developmental disabilities and hospitals, shall utilize the real-time database 23
141	141	created under § 23-17.26-3(a)(4)(vi), and develop and implement a plan to ensure that patients with 24
142	142	mental health disorders, including substance use disorders, who are in need of, and agree to, 25
143	143	clinically appropriate and medically necessary residential, inpatient, or outpatient services are 26
144	144	discharged from hospitals and freestanding emergency-care facilities into such settings as 27
145	145	expeditiously as possible. 28
146	146	(f) On or before March l, 2027, the senate and house committees on health and human 29
147	147	services and/or any other committee deemed appropriate by the president of the senate and the 30
148	148	speaker of the house of representatives shall conduct a hearing on the impact of subsection (e) of 31
149	149	this section to include presentations from payors and providers, and other stakeholders at the 32
150	150	discretion of the committee chairs. 33
151	151	SECTION 2. Chapter 23-17.26 of the General Laws entitled "Comprehensive Discharge 34
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154	154	LC000286 - Page 5 of 8
155	155	Planning" is hereby amended by adding thereto the following section: 1
156	156	23-17.26-5. Comprehensive patient consent form. 2
157	157	Each hospital and freestanding emergency-care facility shall incorporate patient consent 3
158	158	for certified peer recovery specialist services into a comprehensive patient consent form. Consent 4
159	159	for certified peer recovery services shall be contained in its own discrete section of the 5
160	160	comprehensive patient consent form. This section shall be implemented no later than January 1, 6
161	161	2024. 7
162	162	SECTION 3. Section 27-38.2-1 of the General Laws in Chapter 27-38.2 entitled "Insurance 8
163	163	Coverage for Mental Illness and Substance Abuse" is hereby amended to read as follows: 9
164	164	27-38.2-1. Coverage for treatment of mental health and substance use disorders. 10
165	165	Coverage for treatment of mental health disorders, including substance use disorders. 11
166	166	(a) A group health plan and an individual or group health insurance plan, and any contract 12
167	167	between the Rhode Island Medicaid program and any health insurance carrier, as defined under 13
168	168	chapters 18, 19, 20, and 41 of title 27, shall provide coverage for the treatment of mental health and 14
169	169	disorders, including substance use disorders under the same terms and conditions as that coverage 15
170	170	is provided for other illnesses and diseases. 16
171	171	(b) Coverage for the treatment of mental health and disorders, including substance use 17
172	172	disorders shall not impose any annual or lifetime dollar limitation. 18
173	173	(c) Financial requirements and quantitative treatment limitations on coverage for the 19
174	174	treatment of mental health and disorders, including substance use disorders shall be no more 20
175	175	restrictive than the predominant financial requirements applied to substantially all coverage for 21
176	176	medical conditions in each treatment classification. 22
177	177	(d) Coverage shall not impose be subject to non-quantitative treatment limitations for the 23
178	178	treatment of mental health and disorders, including substance use disorders unless the processes, 24
179	179	strategies, evidentiary standards, or other factors used in applying the non-quantitative treatment 25
180	180	limitation, as written and in operation, are comparable to, and are applied no more stringently than, 26
181	181	the processes, strategies, evidentiary standards, or other factors used in applying the limitation with 27
182	182	respect to medical/surgical benefits in the classification. 28
183	183	(e) The following classifications shall be used to apply the coverage requirements of this 29
184	184	chapter: (1) Inpatient, in-network; (2) Inpatient, out-of-network; (3) Outpatient, in-network; (4) 30
185	185	Outpatient, out-of-network; (5) Emergency care; and (6) Prescription drugs. 31
186	186	(f) Medication-assisted treatment or medication-assisted maintenance services of substance 32
187	187	use disorders, opioid overdoses, and chronic addiction, including methadone, buprenorphine, 33
188	188	naltrexone, or other clinically appropriate medications, is included within the appropriate 34
189	189
190	190
191	191	LC000286 - Page 6 of 8
192	192	classification based on the site of the service. 1
193	193	(g) Payors shall rely upon the criteria of the American Society of Addiction Medicine when 2
194	194	developing coverage for levels of care and determining placements for substance use disorder 3
195	195	treatment. 4
196	196	(h) Patients with substance use disorders shall have access to evidence-based, non-opioid 5
197	197	treatment for pain, therefore coverage shall apply to medically necessary chiropractic care and 6
198	198	osteopathic manipulative treatment performed by an individual licensed under § 5-37-2. 7
199	199	(i) Parity of cost-sharing requirements. Regardless of the professional license of the 8
200	200	provider of care, if that care is consistent with the provider’s scope of practice and the health plan’s 9
201	201	credentialing and contracting provisions, cost-sharing for behavioral health counseling visits and 10
202	202	medication maintenance visits shall be consistent with the cost-sharing applied to primary care 11
203	203	office visits. 12
204	204	(j) Consistent with coverage for medical and surgical services, a health plan as defined in 13
205	205	subsection (a) of this section shall cover clinically appropriate and medically necessary residential 14
206	206	or inpatient services, including detoxification and stabilization services, for the treatment of mental 15
207	207	health disorders, including substance use disorders, in accordance with this subsection. 16
208	208	(1) The health plan shall provide coverage for clinically appropriate and medically 17
209	209	necessary residential or inpatient services, including American Society of Addiction Medicine 18
210	210	levels of care for residential and inpatient services, and shall not require preauthorization prior to a 19
211	211	patient obtaining such services, provided that the facility shall provide the health plan notification 20
212	212	of admission, proof that an assessment was conducted based upon the criteria of the American 21
213	213	Society of Addiction Medicine or after an appropriate psychiatric assessment for mental health 22
214	214	disorders, that residential or inpatient services is the most appropriate and least restrictive level of 23
215	215	care necessary, the initial treatment plan, and estimated length of stay within forty-eight hours (48) 24
216	216	of admission. 25
217	217	(2) Notwithstanding § 27-38.2-3, coverage provided under this subsection shall not be 26
218	218	subject to concurrent utilization review during the first twenty-eight (28) days of the residential or 27
219	219	inpatient admission provided that the facility notifies the health plan as provided in subsection (j)(1) 28
220	220	of this section. The facility shall perform daily clinical review of the patient, including consultation 29
221	221	with the health plan at, or just prior to, the fourteenth day of treatment to ensure that the facility 30
222	222	determined that the residential or inpatient treatment was clinically appropriate and medically 31
223	223	necessary for the patient using an assessment based upon the criteria of the American Society of 32
224	224	Addiction Medicine or after an appropriate psychiatric assessment for mental health disorders. 33
225	225	(3) Prior to discharge from residential or inpatient services, the facility shall provide the 34
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228	228	LC000286 - Page 7 of 8
229	229	patient and the health plan with a written discharge plan which shall describe arrangements for 1
230	230	additional services needed following discharge from the residential or inpatient facility as 2
231	231	determined using an assessment based upon the criteria of the American Society of Addiction 3
232	232	Medicine or after an appropriate psychiatric assessment for mental health disorders. Prior to 4
233	233	discharge, the facility shall indicate to the health plan whether services included in the discharge 5
234	234	plan are secured or determined to be reasonably available. The health plan may conduct utilization 6
235	235	review procedures, in consultation with the patient’s treating clinician, regarding the discharge plan 7
236	236	and continuation of care. 8
237	237	(4) Any utilization review of treatment provided under this subsection may include a 9
238	238	review of all services provided during such residential or inpatient treatment, including all services 10
239	239	provided during the first twenty-eight (28) days of such residential or inpatient treatment. Provided, 11
240	240	however, the health plan shall only deny coverage for any portion of the initial twenty-eight (28) 12
241	241	days of residential or inpatient treatment on the basis that such treatment was not medically 13
242	242	necessary if such residential or inpatient treatment was contrary to the assessment based upon the 14
243	243	criteria of the American Society of Addiction Medicine or after an appropriate psychiatric 15
244	244	assessment for mental health disorders. A patient shall not have any financial obligation to the 16
245	245	facility for any treatment under this subsection other than any copayment, coinsurance, or 17
246	246	deductible otherwise required under the policy. 18
247	247	(5) This subsection shall apply only to covered services delivered within the health plan’s 19
248	248	provider network. 20
249	249	(6) Nothing herein prohibits the health plan from conducting quality of care reviews. 21
250	250	(k) No health plan as defined in subsection (a) of this section shall refuse to cover treatment 22
251	251	for mental health disorders, including substance use disorders, regardless of the level of care, that 23
252	252	such health plan is required to cover pursuant to this section solely because such treatment is 24
253	253	ordered by a court of competent jurisdiction or by a government operated diversion program. 25
254	254	(l) On or before March l, 2027, the senate and house committees on health and human 26
255	255	services and/or any other committee deemed appropriate by the president of the senate and the 27
256	256	speaker of the house of representatives shall conduct a hearing on the impact of subsections (j) and 28
257	257	(k) of this section to include presentations from payors and providers, and other stakeholders at the 29
258	258	discretion of the committee chairs. 30
259	259	SECTION 4. This act shall take effect on January 1, 2024. 31
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266	266	EXPLANATION
267	267	BY THE LEGISLATIVE COUNCIL
268	268	OF
269	269	A N A C T
270	270	RELATING TO HEALTH AND SAFETY -- COMPREHENSIVE DISCHA RGE PLANNING
271	271	***
272	272	This act would require a health plan to cover clinically appropriate and medically necessary 1
273	273	residential or inpatient services, including detoxification and stabilization services, for the 2
274	274	treatment of mental health disorders, including substance use disorders. A health plan shall not 3
275	275	require preauthorization prior to a patient obtaining such services provided certain notifications are 4
276	276	provided to the health plan within forty-eight hours (48) of admission. This act would also provide 5
277	277	that such coverage shall not be subject to concurrent utilization review during the first twenty-eight 6
278	278	(28) days of the residential or inpatient admission. 7
279	279	This act would take effect on January 1, 2024. 8
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