2016 -- H 7616

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LC004901

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2016

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A N   A C T

RELATING TO HEALTH AND SAFETY -- INSURANCE--MENTAL ILLNESS AND

SUBSTANCE ABUSE

     Introduced By: Representatives Bennett, Hull, Casey, Slater, and Diaz

     Date Introduced: February 12, 2016

     Referred To: House Corporations

     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

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

     23-17.26-3. Comprehensive discharge planning. -- (a) On or before July 1, 2015 2016,

each hospital operating in the State of Rhode Island shall submit to the director:

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

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

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

shared with patients transitioning from the hospitals care. Such plan shall contain the adoption of

evidence-based practices including, but not limited to:

      (i) Providing in-hospital education prior to discharge;

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

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

questions;

      (iii) Attempting to identify patients' primary care providers and assisting with scheduling

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

      (iv) Expanding the transmission of the department of health's continuity of care form, or

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

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

      (v) Coordinating and improving communication with outpatient providers.

      (3) The discharge plan and transition process shall also be made include recovery

planning tools for patients with opioid and other substance use disorders substance use disorders,

opioid overdoses, and chronic addiction which plan and transition process shall include the

elements contained in subsections (a)(1) or (a)(2) of this section, as applicable. In addition, such

discharge plan and transition process shall also include:

      (i) Assistance, with patient consent, in securing at least one follow-up appointment for

the patient within seven (7) days of discharge, as clinically appropriate:

     (A) With a facility licensed by the department of behavioral healthcare, developmental

disabilities and hospitals to provide treatment of substance use disorders, opioid overdoses, and

chronic addiction;

     (B) With a certified recovery coach;

     (C) With a licensed clinician with expertise in the treatment of substance use disorders,

opioid overdoses, and chronic addiction; or

     (D) With a Rhode Island licensed hospital with a designated program for the treatment of

substance use disorders, opioid overdoses, and chronic addiction. The patient shall be informed of

said appointment prior to the patient being discharged from the hospital;

      (ii) In the absence of a scheduled follow-up appointment pursuant to subsection (a)(3)(i),

every reasonable effort shall be made to contact the patient within thirty (30) days post-discharge

to provide the patient with a referral and other such assistance as the patient needs to obtain a

follow-up appointment; and

      (iii) That the patient receives information about the real-time availability of appropriate

in-patient and out-patient services in Rhode Island.

     (iv) That the patient, or non-patient, presenting to hospitals, health care clinics, urgent

care centers, and emergency room diversion facilities with indication of a substance use disorder,

opioid overdose, or chronic addiction, shall receive information about the real-time availability of

clinically appropriate in-patient and out-patient services for the treatment of substance use

disorders, opioid overdose, or chronic addiction, including:

     (A) Detoxification;

     (B) Stabilization;

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

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

     (D) Recovery coaches.

     (4) On or before November 1, 2014 2016, the director of the department of health shall

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develop and disseminate to all hospitals, health care clinics, urgent care centers, and emergency

room diversion facilities a model discharge plan and transition process for patients with opioid

and other substance use disorders. This model plan may be used as a guide, but may be amended

and modified to meet the specific needs of each hospital, health care clinic, urgent care center and

emergency room diversion facility. with the director of the department of behavioral healthcare,

developmental disabilities and hospitals shall submit revised regulations for patients presenting to

hospitals, health care clinics, urgent care centers, and emergency room diversion facilities with

indication of a substance use disorder, opioid overdose, or chronic addiction to ensure prompt

access to the clinically appropriate in-patient and out-patient services contained in subsection

(a)(3)(iv) of this section. The director of the department of health with the director of the

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

disseminate to all hospitals, health care clinics, urgent care centers, and emergency room

diversion facilities model pre-admission, admission and discharge guidelines, a recovery plan and

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

presenting information on the real-time availability of appropriate in-patient and out-patient

services contained in subsection (a)(3)(iv) of this section. Recommendations from the Rhode

Island governor’s overdose prevention and intervention task force strategic plan may be

incorporated into the model plan as a guide, but may be amended and modified to meet the

specific needs of each hospital, health care clinic, urgent care center and emergency room

diversion facility.

     SECTION 2. Section 27-38.2-1 of the General Laws in Chapter 27-38.2 entitled

"Insurance Coverage for Mental Illness and Substance Abuse" is hereby amended to read as

follows:

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

-- (a) A group health plan and an individual or group health insurance plan shall provide coverage

for the treatment of mental health and substance-use disorders under the same terms and

conditions as that coverage is provided for other illnesses and diseases.

      (b) Coverage for the treatment of mental health and substance-use disorders shall not

impose any annual or lifetime dollar limitation.

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

treatment of mental health and substance-use disorders shall be no more restrictive than the

predominant financial requirements applied to substantially all coverage for medical conditions in

each treatment classification.

      (d) Coverage shall not impose non-quantitative treatment limitations for the treatment of

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mental health and substance-use disorders unless the processes, strategies, evidentiary standards,

or other factors used in applying the non-quantitative treatment limitation, as written and in

operation, are comparable to, and are applied no more stringently than, the processes, strategies,

evidentiary standards, or other factors used in applying the limitation with respect to

medical/surgical benefits in the classification.

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

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

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

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

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

buprenorphine, naltrexone or other clinically appropriate medications, maintenance services, for

the treatment of substance-use disorders, opioid overdoses, and chronic addiction is included

within the appropriate classification based on the site of the service.

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

when developing coverage for levels of care for substance-use disorder treatment.

     SECTION 3. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO HEALTH AND SAFETY -- INSURANCE--MENTAL ILLNESS AND

SUBSTANCE ABUSE

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     This act would require comprehensive discharge planning for patients treated for

substance use disorders and would require insurers to cover medication-assisted addiction

treatment including methadone, buprenorphine, and naltrexone.

     This act would take effect upon passage.

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