Chapter 206
2017 -- H 6306 SUBSTITUTE A
Enacted 07/18/2017

A N   A C T
RELATING TO HEALTH AND SAFETY - COMPREHENSIVE DISCHARGE PLANNING

Introduced By: Representatives Canario, Lima, McLaughlin, Fellela, and Bennett
Date Introduced: June 08, 2017

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 January 1, 2017, each hospital and freestanding, emergency-care facility
operating in the state of Rhode Island shall submit to the director a comprehensive discharge plan
that includes:
     (1) Evidence of participation in a high-quality, comprehensive discharge-planning and
transitions-improvement project operated by a nonprofit organization in this state; or
     (2) A plan for the provision of comprehensive discharge planning and information to be
shared with patients transitioning from the 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 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;
     (iv) Attempting to identify patients' primary care providers and assisting with scheduling
post-discharge follow-up appointments prior to patient discharge;
     (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
     (vi) Coordinating and improving communication with outpatient providers.
     (3) The discharge plan and transition process shall include recovery planning tools for
patients with substance-use disorders, opioid overdoses, and chronic addiction, which plan and
transition process shall include the elements contained in subsections (a)(1) or (a)(2), as
applicable. In addition, such discharge plan and transition process shall also include:
     (i) That, 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)(4)(ii), before discharge. Prior to the dissemination of the standards in subsection
(a)(4)(ii), 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;
     (ii) That if, after the completion of a substance-abuse evaluation, in accordance with the
standards in subsection (a)(4)(ii), the clinically appropriate inpatient and outpatient services for
the treatment of substance-use disorders, opioid overdose, or chronic addiction contained in
subsection (a)(3)(iv) are not immediately available, the hospital or freestanding, emergency-care
facility shall provide medically necessary and appropriate services with patient consent, until the
appropriate transfer of care is completed;
     (iii) That, with patient consent, pursuant to 21 C.F.R. ยง 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. Not 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;
     (iv) 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)(4)(v), 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
     (v) That, when the real-time patient-services database outlined in subsection (a)(4)(vi)
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) On or before January 1, 2017, the director of the department of health, 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 patient screening, transfer, and
referral to clinically appropriate inpatient and outpatient services contained in subsection
(a)(3)(iv);
     (v) Develop 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)(3)(iv);
     (vi) Develop a strategy to assess, create, implement, and maintain a database of real-time
availability of clinically appropriate inpatient and outpatient services contained in subsection
(a)(3)(iv) of this section on or before January 1, 2018.
     (5) On or before September 1, 2017, each hospital and freestanding, emergency-care
facility operating in the state of Rhode Island shall submit to the director a discharge plan and
transition process that shall include provisions for patients with a primary diagnosis of a mental
health disorder without a co-occurring substance use disorder.
     (6) On or before January 1, 2018, the director of the department of health, with the
director of the department of behavioral healthcare, developmental disabilities, and hospitals,
shall develop and disseminate mental health best practices standards for health care clinics, urgent
care centers, and emergency diversion facilities regarding protocols for patient screening,
transfer, and referral to clinically appropriate inpatient and outpatient services. The best practice
standards shall include information and strategies to facilitate clinically appropriate prompt
transfers and referrals from hospitals and freestanding, emergency-care facilities to less intensive
settings.
     SECTION 2. This act shall take effect upon passage.
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LC002825/SUB A
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