2011 -- S 0875 SUBSTITUTE A

Enacted 05/25/11








     Introduced By: Senators Perry, Crowley, Jabour, Metts, and Miller

     Date Introduced: April 14, 2011




     SECTION 1. WHEREAS, Untreated substance use disorders, problems of homelessness,

poverty and chronic illness contribute to poor health outcomes and frequent use of hospital

emergency departments; and

     WHEREAS, The underlying need for clinically appropriate diversion includes: increased

complexity and acuity of patients presenting to emergency departments; increase in patient

volume; lack of beds for patients admitted to hospitals; and shortage of physical space within the

emergency department; and

     WHEREAS, In 2008 the Rhode Island Medicaid program reports spending a total of $52

million on emergency department expenses alone; and

     WHEREAS, Visits to the Emergency Department are generally the most costly form of

care, but not always the most effective alternative for care; and

     WHEREAS, According to the 2006 National Survey on Drug Use and Health the total

number of individuals dependent or abusing alcohol and drugs was 107,000 or 11.34% percent of

the 12 or older population in Rhode Island; and

     WHEREAS, Diversion is the practice of redirecting an ambulance away from a hospital's

emergency department when clinically appropriate, and has become a well-documented national

practice; and

     WHEREAS, Diversion may be one strategy to cope with the temporary mismatches of

demand for emergency care and supply of emergency care treatment capacity, and

     WHEREAS, Public emergency departments could refer large numbers of patients to

appointments at alternative care facilities if the availability and coordination of primary care

services were enhanced to provide comprehensive clinical supports; and

     WHEREAS, That the senate hereby establishes a special senate commission to convene

to discuss and develop short-term and long-term strategies to improve hospital service delivery

and utilization of emergency departments in order to meet the health needs of Rhode Islanders;

now, therefore, be it

     RESOLVED, That the special senate commission to study Rhode Island emergency

department diversion is hereby created and shall consist of nineteen (19) members to be

appointed by the senate president, as follows:

     Three (3) of whom shall be members of the senate, not more than two (2) from the same

political party; one of whom shall be the director of behavioral health disabilities and hospitals, or

his or her designee; one of whom shall be the director of human services, or his or her designee;

one of whom shall be the director of department of health, or his or her designee; one of whom

shall be a representative from an independent hospital; three (3) of whom shall be representatives

from hospitals affiliated with a major health care system; one emergency room physician; one

representative from the Rhode Island ambulance service advisory board; one representative of a

local police department; one representative of a local fire department; one representative from a

Medicaid health insurer; one representative of whom shall be a researcher/epidemiologist

specializing in substance use disorders; and three (3) of whom shall be representatives of

community based providers that serve the substance abuse, mental health and/or uninsured

populations. The commission shall have two (2) co-chairs from among its members, to be

appointed by the president of the senate.

     The commission shall be charged with studying and making recommendations regarding

the issue of emergency room diversions for individuals with substance abuse disorders. In

studying this issue the commission is encouraged to:

     (1) Examine trends, current policies, and data pertaining to Rhode Island hospitals

emergency department utilization and emergency department diversion;

     (2) Identify regulatory restrictions which currently prevent Rhode Island emergency

diversion initiatives; 

     (3) Provide a forum for state agencies, community-based organizations, faith-based

organizations, volunteer organizations, advocacy groups and businesses to discuss challenges and

solutions pertaining to emergency department diversion;

     (4) Examine current models that are being used by other states or municipalities to

mitigate the problem;

     (5) Identify and seek ways to remedy gaps in alternatives, specifically in the area of

making provisions for the availability and use.  In particular, identify permanent funding stream

options for emergency department alternative facilities.

     Forthwith upon passage of this resolution, the members of the commission shall meet at

the call of the senate president. Vacancies in said commission shall be filled in like manner as the

original appointment.

     The membership of said commission shall receive no compensation for their services.

     All departments and agencies of the state shall furnish such advice and information,

documentary and otherwise, to said commission and its agents as is deemed necessary or

desirable by the commission to facilitate the purposes of this resolution.

     The joint committee on legislative services is hereby authorized and directed to provide

suitable quarters for said commission; and be it further

     RESOLVED, That the commission shall report its findings and recommendations to the

senate no later than January 31, 2012, and said commission shall expire on May 31, 2012.



LC02365/SUB A