Chapter
400
2005 -- H 5829 SUBSTITUTE A
Enacted 07/19/05
A N A C T
RELATING TO STATE
AFFAIRS AND GOVERNMENT -- DEPARTMENT OF CHILDREN,
YOUTH AND FAMILIES
Introduced By: Representatives Slater, and Costantino
Date Introduced: March 01,
2005
It is enacted
by the General Assembly as follows:
SECTION
1. Chapter 42-72 of the General Laws entitled "Children, Youth, and
Families
Department"
is hereby amended by adding thereto the following section:
42-72-5.2.
Development of a continuum of children's behavioral health programs. –
The
departments of children, youth and families (DCYF) and human services (DHS)
shall
cooperate
to develop a design of a continuum of care for children's behavioral health
services that
encourages
the use of alternative psychiatric and other services to hospitalization and
reviews the
utilization
of each service in order to better match services and programs to the needs of
the
children
and families as well as continuously improve the quality of and access to services.
The
departments
of children, youth and families and human services shall present a report to
the
governor
and the general assembly no later than January 1, 2006 that fully described
this
continuum
of services and outlines a detailed plan for its implementation, including
resource
requirements,
responsibilities, milestones, and time frames, as well as a set of indicators
and
program
metrics that will be employed to evaluate its clinical and fiscal effectiveness
over time.
The
report shall also describe any and all changes proposed in program oversight or
budgetary
responsibility
for specific services. An important step towards the development of such
continuum
of care is to assure the appropriate management of psychiatric
hospitalizations. To that
end
the state shall:
(1)
Amend contractual agreements with RIte Care health plans to reflect complete
responsibility
for the management of psychiatric hospitalizations, specifically the
development of
hospital
diversion and post discharge services; and the utilization of crisis
intervention services as
a
requirement for authorization of a psychiatric admission for all children
enrolled in RIte Care;
and
(2)
Issue a request for proposals to identify a contracted entity to reflect
complete
responsibility
for the management of psychiatric hospitalizations, specifically the
development of
hospital
diversion and post discharge services for crisis intervention services as a
requirement for
authorization
of a psychiatric admission for all Medicaid-eligible children not enrolled in
RIte
Care.
The request for proposals shall include a dispute resolution process.
SECTION
2. Sections 40.1-5-6 and 40.1-5-26 of the General Laws in Chapter 40.1-5
entitled
"Mental Health Law" are hereby amended to read as follows:
40.1-5-6.
Voluntary admission. -- (a)(1) General. - Any individual of
lawful age may
apply
for voluntary admission to any facility provided for by this law seeking care
and treatment
for alleged
mental disability. The application shall be in writing, signed by the applicant
in the
presence
of at least one witness, who shall attest to the application by placing his or
her name and
address
thereon. If the applicant has not yet attained his or her eighteenth birthday,
the application
shall be
signed by him or her and his or her parent, guardian, or next of kin.
(2)
Admission of children. Any person who is under the age of eighteen (18) and who
receives
medical benefits funded in whole or in part by either the department of
children, youth
and
families or by the department of human services may be admitted to any facility
provided for
by
this chapter seeking care and treatment for alleged mental disability only
after an initial mental
health
crisis intervention is completed by a provider that is licensed by the
department of
children,
youth and families for emergency services, has proper credentials and is
contracted with
the
RIte Care health plan or the state and said provider, after considering
alternative services to
hospitalization
with the child, family and other providers, requests prior authorization for
the
admission
from a representative of the child and family's insurance company or
utilization review
organization
representing the insurance company. If the inpatient hospital admits a child
without
the
crisis intervention and prior authorization from the insurance company or
utilization review
organization,
the hospital will be paid a rate equivalent to an Administratively Necessary
Day
(AND)
for each day that the insurance company or utilization review organization
representing
the
insurance company determines that the child did not meet the inpatient level of
care criteria.
The
state shall ensure that this provision is included in all publicly financed
contracts and
agreements
for behavioral health services. Activities conducted pursuant to this section
shall be
exempt
from the provisions of section 23-17.12, but shall be subject to the provisions
of
subsection
40.1-5-6(b).
(3)
The department of human services shall develop regulations for emergency
admissions,
that would allow the admitting hospital to maintain their compliance with the
provisions
of the act, while meeting the need of the child.
(b) Period of treatment. - If it is determined that the applicant is in need of
care and
treatment
for mental disability and no suitable alternatives to admission are available,
he or she
shall be
admitted for a period not to exceed thirty (30) days. Successive applications
for
continued
voluntary status may be made for successive periods not to exceed ninety (90)
days
each, so
long as care and treatment is deemed necessary and documented in accordance
with the
requirements
of this chapter, and no suitable alternatives to admission are available.
(c) Discharge. - (1) A voluntary patient shall be discharged no later than the
end of the
business
day following of his or her presenting a written notice of his or her
intent to leave the
facility
to the medical official in charge or the medical official designated by him or
her, unless
that
official or another qualified person from the facility files an application for
the patient's civil
court
certification pursuant to section 40.1-5-8. The notice shall be on a form
prescribed by the
director
and made available to all patients at all times. If a decision to file an
application for civil
court
certification is made, the patient concerned and his or her legal guardian(s),
if any, shall
receive
immediately, but in no event later than twelve (12) hours from the making of
the decision,
notice
of the intention from the official in charge of the facility, or his or her
designee, and the
patient
may, in the discretion of the official, be detained for an additional period
not to exceed
two (2)
business days, pending the filing and setting down for hearing of the
application under
section
40.1-5-8.
(2) A voluntary patient who gives notice of his or her intention or desire to
leave the
facility
may at any time during the period of his or her hospitalization prior to any
certification
pursuant
to section 40.1-5-8, following the giving of the notice, submit a written
communication
withdrawing
the notice, whereby his or her voluntary status shall be considered to continue
unchanged
until the expiration of thirty (30) or ninety (90) days as provided in
subsection (b). In
the case
of an individual under eighteen (18) years of age, the notice or withdrawal of
notice may
be given
by either of the persons who made the application for his or her admission, or
by a
person
of equal or closer relationship to the patient, who shall, as well, receive
notice from the
official
in charge indicating a decision to present an application for civil court
certification. The
official
may in his or her discretion refuse to discharge the patient upon notice given
by any
person
other than the person who made the application, and in the event of such a
refusal the
person
giving notice may apply to a justice of the family court for release of the
patient.
(d) Examination at facility. - The medical official in charge of a facility
shall ensure that
all
voluntary patients receive preliminary physical and psychiatric examinations
within twenty-
four
(24) hours of admission. Furthermore, a complete psychiatric examination shall
be
conducted
to determine whether the person qualifies for care and treatment under the
provisions
of this
chapter. The examination shall begin within forty-eight (48) hours of admission
and shall
be
concluded as soon as practicable, but in no case shall extend beyond five (5)
days. The
examination
shall include an investigation with the prospective patient of (1) what
alternatives for
admission
are available and (2) why those alternatives are not suitable. The alternatives
for
admission
investigated and reasons for unsuitability, if any, shall be recorded on the
patient's
record.
If it is determined that the patient does not belong to the voluntary class in
that a suitable
alternative
to admission is available, or is otherwise ineligible for care and treatment,
he or she
shall be
discharged.
(e) Rights of voluntary patients. - A voluntary patient shall be informed in
writing of his
or her
status and rights as a voluntary patient immediately upon his or her admission,
and again at
the time
of his or her periodic review(s) as provided in section 40.1-5-10, including
his or her
rights
pursuant to section 40.1-5-5(f). Blank forms for purposes of indicating an
intention or
desire
to leave a facility shall be available at all times and on and in all wards and
segments of a
facility
wherein voluntary patients may reside.
40.1-5-26.
Disclosure of confidential information and records. -- (a) The fact of
admission
or certification and all information and records compiled, obtained, or
maintained in
the
course of providing services to persons under this chapter shall be
confidential.
(b) Information and records may be disclosed only:
(1) To any person, with the written consent of the patient or his or her
guardian.
(2) In communications among qualified medical or mental health professionals in
the
provision
of services or appropriate referrals, or in the course of court proceedings.
The consent
of the
patient, or his or her guardian, must be obtained before information or records
may be
disclosed
by a professional person employed by a facility to a professional person not
employed
by the
facility who does not have the medical responsibility for the patient's care.
(3) When the person receiving services, or his or her guardian, designates
persons to
whom
information or records may be released, or if the person is a minor, when his
or her parents
or
guardian make the designation.
(4) To the extent necessary for a recipient to make a claim, or for a claim to
be made on
behalf
of a recipient for aid, insurance, or medical assistance to which he or she may
be entitled.
(5) To proper medical authorities for the purpose of providing emergency
medical
treatment
where the person's life or health are in immediate jeopardy.
(6) For program evaluation and/or research, provided that the director adopts
rules for
the
conduct of the evaluations and/or research. The rules shall include, but need
not be limited to,
the
requirement that all evaluators and researchers must sign an oath of
confidentiality, agreeing
not to
divulge, publish, or otherwise make known, to unauthorized persons or the
public, any
information
obtained in the course of the evaluation or research regarding persons who have
received
services such that the person who received the services is identifiable.
(7) To the courts and persons designated by judges thereof in accordance with
applicable
rules of
procedure. The records and files maintained in any court proceeding pursuant to
this
chapter
shall be confidential and available only to the person who was the subject of the
proceeding
or his or her attorney.
(8) To the state medical examiner in connection with the investigation of a
fatality of a
current
or former patient to the extent necessary to assist the medical examiner in
determining the
cause of
death.
(9) To the director of health in accordance with and to the extent authorized
by the
provisions
of chapter 37.3 of title 5 and all applicable federal laws and regulations,
provided
however
that with respect to any information obtained, the department complies with all
state and
federal
confidentiality laws, including but not limited to, chapter 37.3 of title 5 and
specifically
section
5-37.3-4(c), and that the name or name(s) of the patient(s) who is or are
determined by the
director
of health to be immaterial to the request, inquiry or investigation remain
unidentifiable.
Any
treatment facility which provides information to the director of health in
accord with a
request
under this subsection is not liable for wrongful disclosure arising out of any
subsequent
disclosure
by the director of health.
(10) To a probate court of competent jurisdiction, petitioner, respondent,
and/or their
attorneys,
when the information is contained within a decision-making assessment tool
which
conforms
to the provisions of section 33-15-47.
(11)
To the department of children, youth and families or the department's
contracted
designee
pursuant to section 42-72-5.2(2) for children hospitalized for psychiatric
services and
such
placement is supported by the department or for a child who may be discharged
from an
acute
care facility to an out-of-home placement supported by the department, for the
purpose of
effective
care planning.
(12)
To the RIte Care health plans for any child enrolled in RIte Care.
SECTION
3. Section 1 of this act shall take effect upon passage. Section 2 of this act
shall take effect on May 1,
2006.
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LC02125/SUB A/3
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