2016 -- S 2356 SUBSTITUTE A

========

LC004564/SUB A/2

========

     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2016

____________

A N   A C T

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

SUBSTANCE ABUSE - THE ALEXANDER C. PERRY ACT

     Introduced By: Senators Miller, Jabour, Crowley, Goodwin, and Satchell

     Date Introduced: February 10, 2016

     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

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

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

September 1, 2016, each hospital and freestanding emergency care facility operating in the State

of Rhode Island shall submit to the director:

     (1) With patient consent, each patient presenting to a hospital or freestanding emergency

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

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

(a)(5)(ii) of this section, before discharge. Prior to the dissemination of the standards in

subsection (a)(5)(ii) of this section, with patient consent, each patient presenting to a hospital or

freestanding emergency care facility with indication of a substance use disorder, opioid overdose,

or chronic addiction shall receive a substance abuse evaluation, in accordance with best practices

standards, before discharge.

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

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

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

be shared with patients transitioning from the hospitals hospital's or freestanding emergency care

facility's care. Such plan shall contain the adoption of evidence-based practices including, but not

limited to:

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

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) With patient consent, attempting to notify the person(s) listed as the patient's

emergency contacts and recovery coach before discharge. If the patient refuses to consent to the

notification of emergency contacts, such refusal shall be noted in the patient's medical record;

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

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

     (iv)(v) 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)(vi) Coordinating and improving communication with outpatient providers.

     (3)(4) 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) (a)(2) or (a)(2) (a)(3) 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; (B) With a certified recovery coach; (C) With a

licensed clinician with expertise in the treatment of substance use disorders; or (D) With a Rhode

Island licensed hospital with a designated program for the treatment of substance use disorders.

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.

LC004564/SUB A/2 - Page 2 of 5

     (i) That if, after the completion of a substance abuse evaluation, in accordance with the

standards in subsection (a)(5)(ii) of this section, the clinically appropriate inpatient and outpatient

services for the treatment of substance use disorders, opioid overdose, or chronic addiction

contained in subsection (a)(4)(iii) of this section are not immediately available, the hospital or

freestanding emergency care facility shall provide medically necessary and appropriate services

until the appropriate transfer of care is completed;

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

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

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

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

being made for referral for treatment. No more than one day's medication may be administered to

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

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

     (iii) That each patient presenting to a hospital or freestanding emergency care facility

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

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

with subsection (a)(5)(v) of this section, about the availability of clinically appropriate inpatient

and outpatient 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;

     (D) Inpatient and residential treatment;

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

overdoses, and chronic addiction;

     (F) Certified recovery coaches; and

     (iv) That when the real-time patient services database outlined in subsection (a)(5)(vi) of

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

or freestanding emergency care facility about the availability of clinically appropriate inpatient

and outpatient services.

     (4)(5) On or before November 1, 2014 January 1, 2017, the director of the department of

health, shall 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

LC004564/SUB A/2 - Page 3 of 5

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:

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

regulatory standard for the early introduction of a recovery coach during the pre-admission and/or

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

addiction;

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

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

or chronic addiction;

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

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

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

Recommendations from the 2015 Rhode Island Governor's overdose prevention and intervention

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

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

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

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

to clinically appropriate inpatient and outpatient services contained in subsection (a)(4)(iii) of this

section;

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

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

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

contained in subsection (a)(4)(iii) of this section;

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

availability of clinically appropriate inpatient and outpatient services contained in subsection

(a)(4)(iii) of this section on or before January 1, 2018.

     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

LC004564/SUB A/2 - Page 4 of 5

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

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 including methadone, 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.

========

LC004564/SUB A/2

========

LC004564/SUB A/2 - Page 5 of 5

EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

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

SUBSTANCE ABUSE - THE ALEXANDER C. PERRY ACT

***

     This act would require comprehensive discharge planning for patients treated for

substance use disorders, opioid overdoses, and chronic addiction and would require insurers to

cover medication-assisted addiction treatment including methadone, buprenorphine, and

naltrexone.

     This act would take effect upon passage.

========

LC004564/SUB A/2

========

LC004564/SUB A/2 - Page 6 of 5