2017 -- S 0332 SUBSTITUTE A

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LC001497/SUB A

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2017

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A N   A C T

RELATING TO HEALTH AND SAFETY - COMPREHENSIVE DISCHARGE PLANNING

     

     Introduced By: Senators Miller, Goldin, Satchell, Crowley, and Sosnowski

     Date Introduced: February 16, 2017

     Referred To: Senate Health & Human Services

     It is enacted by the General Assembly as follows:

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     SECTION 1. Section 23-17.26-3 of the General Laws in Chapter 23-17.26 entitled

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

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     23-17.26-3. Comprehensive discharge planning.

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     (a) On or before January 1, 2017, each hospital and freestanding, emergency-care facility

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operating in the state of Rhode Island shall submit to the director a comprehensive discharge plan

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that includes:

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

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

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

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shared with patients transitioning from the hospital's or freestanding, emergency-care facility's

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

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to:

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

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discharge;

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

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

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questions;

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

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

 

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

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

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

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

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

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

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     (vi) Coordinating and improving communication with outpatient providers.

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     (3) The discharge plan and transition process shall include recovery planning tools for

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patients with substance-use disorders, opioid overdoses, and chronic addiction, which plan and

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transition process shall include the elements contained in subsections (a)(1) or (a)(2), as

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applicable. In addition, such discharge plan and transition process shall also include:

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     (i) That, with patient consent, each patient presenting to a hospital or freestanding,

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

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

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subsection (a)(4)(ii), before discharge. Prior to the dissemination of the standards in subsection

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(a)(4)(ii), with patient consent, each patient presenting to a hospital or freestanding, emergency-

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

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shall receive a substance-abuse evaluation, in accordance with best practices standards, before

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discharge;

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

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standards in subsection (a)(4)(ii), the clinically appropriate inpatient and outpatient services for

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the treatment of substance-use disorders, opioid overdose, or chronic addiction contained in

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subsection (a)(3)(iv) are not immediately available, the hospital or freestanding, emergency-care

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facility shall provide medically necessary and appropriate services with patient consent, until the

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appropriate transfer of care is completed;

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     (iii) That, with patient consent, pursuant to 21 C.F.R. ยง 1306.07, a physician in a hospital

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

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

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purpose of relieving acute, opioid-withdrawal symptoms, when necessary, while arrangements

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are being made for referral for treatment. Not more than one day's medication may be

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

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

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     (iv) That each patient presenting to a hospital or freestanding, emergency-care facility

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

 

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

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with subsection (a)(4)(v), about the availability of clinically appropriate inpatient and outpatient

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

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including:

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     (A) Detoxification;

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     (B) Stabilization;

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

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

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     (D) Inpatient and residential treatment;

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

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overdoses, and chronic addiction;

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     (F) Certified recovery coaches; and

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     (v) That, when the real-time patient services database outlined in subsection (a)(4)(vi)

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

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freestanding, emergency-care facility about the availability of clinically appropriate inpatient and

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outpatient services.

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     (4) On or before January 1, 2017, the director of the department of health, with the

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director of the department of behavioral healthcare, developmental disabilities and hospitals,

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shall:

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

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

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

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addiction;

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

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

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or chronic addiction;

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

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

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

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

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

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and modified to meet the specific needs of each hospital and freestanding, emergency-care

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facility;

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

 

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centers, and emergency-diversion facilities regarding protocols for patient screening, transfer, and

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referral to clinically appropriate inpatient and outpatient services contained in subsection

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(a)(3)(iv);

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     (v) Develop regulations for patients presenting to hospitals and freestanding, emergency-

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

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

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contained in subsection (a)(3)(iv);

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

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availability of clinically appropriate inpatient and outpatient services contained in subsection

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(a)(3)(iv) of this section on or before January 1, 2018.

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     (5) On or before September 1, 2017, each hospital and freestanding emergency care

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facility operating in the state of Rhode Island shall submit to the director a discharge plan and

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transition process that shall include provisions for patients with a primary diagnosis of a mental

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health disorder without a co-occurring substance use disorder.

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     (6) On or before January 1, 2018, the director of the department of health, with the

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director of the department of behavioral healthcare, developmental disabilities, and hospitals,

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shall develop and disseminate mental health best practices standards for health care clinics, urgent

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care centers, and emergency diversion facilities regarding protocols for patient screening,

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transfer, and referral to clinically appropriate inpatient and outpatient services. The best practice

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standards shall include information and strategies to facilitate clinically appropriate prompt

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transfers and referrals from hospitals and freestanding emergency care facilities to less intensive

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settings.

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     SECTION 2. 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 - COMPREHENSIVE DISCHARGE PLANNING

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     This act would require medical treatment facilities to provide discharge plans for patients

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with nonsubstance abuse related mental health disorders.

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     This act would take effect upon passage.

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