2023 -- S 0027

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LC000286

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2023

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A N   A C T

RELATING TO HEALTH AND SAFETY -- COMPREHENSIVE DISCHARGE 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:

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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 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) Encouraging notification of the person(s) listed as the patient’s emergency contacts

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and certified peer recovery specialist to the extent permitted by lawful patient consent or applicable

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law, including, but not limited to, the Federal Health Insurance Portability and Accountability Act

 

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of 1996, as amended, and 42 C.F.R. Part 2, as amended. The policy shall also require all attempts

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at notification to 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 subsection (a)(1) or (a)(2), as applicable.

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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 use evaluation, in accordance with the standards in subsection

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

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patient consent, each patient presenting to a hospital or freestanding emergency-care facility with

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

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substance use evaluation, in accordance with best practices standards, before discharge;

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

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

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

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

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

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transfer of care is completed;

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     (iii) That, with patient consent, pursuant to 21 C.F.R. § 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 are

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being made for referral for treatment. Not more than one day’s medication may be administered to

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

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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 with

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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 mental health disorders, including substance use disorders, opioid

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overdose, or chronic addiction, 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) Outpatient, Inpatient 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; and

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     (F) Certified peer recovery specialists; 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 director

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of the department of behavioral healthcare, developmental disabilities and hospitals, 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 certified peer recovery specialist during the pre-

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

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chronic addiction;

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

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

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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 facility;

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     (iv) Develop and disseminate best practices standards for healthcare 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 (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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     (b) Nothing contained in this chapter shall be construed to limit the permitted disclosure of

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confidential healthcare information and communications permitted in § 5-37.3-4(b)(4)(i) of the

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confidentiality of health care communications act.

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     (c) On or before September 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 discharge plan and transition

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

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disorder without a co-occurring substance use disorder.

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

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

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and disseminate mental health best practices standards for healthcare clinics, urgent care centers,

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

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to clinically appropriate inpatient and outpatient services. The best practice standards shall include

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information and strategies to facilitate clinically appropriate prompt transfers and referrals from

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hospitals and freestanding emergency-care facilities to less intensive settings.

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     (e) The director of the department of health, with the director of the department of

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behavioral healthcare, developmental disabilities and hospitals, shall utilize the real-time database

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created under § 23-17.26-3(a)(4)(vi), and develop and implement a plan to ensure that patients with

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mental health disorders, including substance use disorders, who are in need of, and agree to,

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clinically appropriate and medically necessary residential, inpatient, or outpatient services are

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discharged from hospitals and freestanding emergency-care facilities into such settings as

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expeditiously as possible.

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     (f) On or before March l, 2027, the senate and house committees on health and human

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services and/or any other committee deemed appropriate by the president of the senate and the

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speaker of the house of representatives shall conduct a hearing on the impact of subsection (e) of

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this section to include presentations from payors and providers, and other stakeholders at the

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discretion of the committee chairs.

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     SECTION 2. Chapter 23-17.26 of the General Laws entitled "Comprehensive Discharge

 

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Planning" is hereby amended by adding thereto the following section:

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     23-17.26-5. Comprehensive patient consent form.

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     Each hospital and freestanding emergency-care facility shall incorporate patient consent

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for certified peer recovery specialist services into a comprehensive patient consent form. Consent

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for certified peer recovery services shall be contained in its own discrete section of the

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comprehensive patient consent form. This section shall be implemented no later than January 1,

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2024.

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     SECTION 3. Section 27-38.2-1 of the General Laws in Chapter 27-38.2 entitled "Insurance

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

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

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Coverage for treatment of mental health disorders, including substance use disorders.

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     (a) A group health plan and an individual or group health insurance plan, and any contract

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between the Rhode Island Medicaid program and any health insurance carrier, as defined under

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chapters 18, 19, 20, and 41 of title 27, shall provide coverage for the treatment of mental health and

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disorders, including substance use disorders under the same terms and conditions as that coverage

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is provided for other illnesses and diseases.

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     (b) Coverage for the treatment of mental health and disorders, including substance use

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disorders shall not impose any annual or lifetime dollar limitation.

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

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treatment of mental health and disorders, including substance use disorders shall be no more

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restrictive than the predominant financial requirements applied to substantially all coverage for

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medical conditions in each treatment classification.

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     (d) Coverage shall not impose be subject to non-quantitative treatment limitations for the

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treatment of mental health and disorders, including substance use disorders unless the processes,

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strategies, evidentiary standards, or other factors used in applying the non-quantitative treatment

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limitation, as written and in operation, are comparable to, and are applied no more stringently than,

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the processes, strategies, evidentiary standards, or other factors used in applying the limitation with

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respect to medical/surgical benefits in the classification.

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

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

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

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

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

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naltrexone, or other clinically appropriate medications, is included within the appropriate

 

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classification based on the site of the service.

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

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developing coverage for levels of care and determining placements for substance use disorder

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treatment.

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     (h) Patients with substance use disorders shall have access to evidence-based, non-opioid

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treatment for pain, therefore coverage shall apply to medically necessary chiropractic care and

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osteopathic manipulative treatment performed by an individual licensed under § 5-37-2.

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     (i) Parity of cost-sharing requirements. Regardless of the professional license of the

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provider of care, if that care is consistent with the provider’s scope of practice and the health plan’s

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credentialing and contracting provisions, cost-sharing for behavioral health counseling visits and

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medication maintenance visits shall be consistent with the cost-sharing applied to primary care

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office visits.

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     (j) Consistent with coverage for medical and surgical services, a health plan as defined in

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subsection (a) of this section shall cover clinically appropriate and medically necessary residential

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or inpatient services, including detoxification and stabilization services, for the treatment of mental

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health disorders, including substance use disorders, in accordance with this subsection.

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     (1) The health plan shall provide coverage for clinically appropriate and medically

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necessary residential or inpatient services, including American Society of Addiction Medicine

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levels of care for residential and inpatient services, and shall not require preauthorization prior to a

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patient obtaining such services, provided that the facility shall provide the health plan notification

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of admission, proof that an assessment was conducted based upon the criteria of the American

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Society of Addiction Medicine or after an appropriate psychiatric assessment for mental health

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disorders, that residential or inpatient services is the most appropriate and least restrictive level of

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care necessary, the initial treatment plan, and estimated length of stay within forty-eight hours (48)

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of admission.

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     (2) Notwithstanding § 27-38.2-3, coverage provided under this subsection shall not be

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subject to concurrent utilization review during the first twenty-eight (28) days of the residential or

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inpatient admission provided that the facility notifies the health plan as provided in subsection (j)(1)

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of this section. The facility shall perform daily clinical review of the patient, including consultation

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with the health plan at, or just prior to, the fourteenth day of treatment to ensure that the facility

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determined that the residential or inpatient treatment was clinically appropriate and medically

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necessary for the patient using an assessment based upon the criteria of the American Society of

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Addiction Medicine or after an appropriate psychiatric assessment for mental health disorders.

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     (3) Prior to discharge from residential or inpatient services, the facility shall provide the

 

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patient and the health plan with a written discharge plan which shall describe arrangements for

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additional services needed following discharge from the residential or inpatient facility as

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determined using an assessment based upon the criteria of the American Society of Addiction

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Medicine or after an appropriate psychiatric assessment for mental health disorders. Prior to

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discharge, the facility shall indicate to the health plan whether services included in the discharge

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plan are secured or determined to be reasonably available. The health plan may conduct utilization

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review procedures, in consultation with the patient’s treating clinician, regarding the discharge plan

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and continuation of care.

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     (4) Any utilization review of treatment provided under this subsection may include a

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review of all services provided during such residential or inpatient treatment, including all services

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provided during the first twenty-eight (28) days of such residential or inpatient treatment. Provided,

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however, the health plan shall only deny coverage for any portion of the initial twenty-eight (28)

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days of residential or inpatient treatment on the basis that such treatment was not medically

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necessary if such residential or inpatient treatment was contrary to the assessment based upon the

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criteria of the American Society of Addiction Medicine or after an appropriate psychiatric

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assessment for mental health disorders. A patient shall not have any financial obligation to the

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facility for any treatment under this subsection other than any copayment, coinsurance, or

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deductible otherwise required under the policy.

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     (5) This subsection shall apply only to covered services delivered within the health plan’s

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provider network.

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     (6) Nothing herein prohibits the health plan from conducting quality of care reviews.

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     (k) No health plan as defined in subsection (a) of this section shall refuse to cover treatment

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for mental health disorders, including substance use disorders, regardless of the level of care, that

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such health plan is required to cover pursuant to this section solely because such treatment is

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ordered by a court of competent jurisdiction or by a government operated diversion program.

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     (l) On or before March l, 2027, the senate and house committees on health and human

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services and/or any other committee deemed appropriate by the president of the senate and the

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speaker of the house of representatives shall conduct a hearing on the impact of subsections (j) and

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(k) of this section to include presentations from payors and providers, and other stakeholders at the

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discretion of the committee chairs.

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     SECTION 4. This act shall take effect on January 1, 2024.

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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 a health plan to cover clinically appropriate and medically necessary

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residential or inpatient services, including detoxification and stabilization services, for the

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treatment of mental health disorders, including substance use disorders. A health plan shall not

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require preauthorization prior to a patient obtaining such services provided certain notifications are

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provided to the health plan within forty-eight hours (48) of admission. This act would also provide

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that such coverage shall not be subject to concurrent utilization review during the first twenty-eight

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(28) days of the residential or inpatient admission.

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     This act would take effect on January 1, 2024.

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