Chapter 038 |
2019 -- S 0139 SUBSTITUTE A Enacted 06/28/2019 |
A N A C T |
RELATING TO HEALTH AND SAFETY -- COMPREHENSIVE DISCHARGE PLANNING |
Introduced By: Senators Miller, Goodwin, McCaffrey, Goldin, and Satchell |
Date Introduced: January 24, 2019 |
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 |
Encouraging notification of the person(s) listed as the patient's emergency contacts and certified |
peer recovery specialist to the extent permitted by lawful patient consent or applicable law, |
including, but not limited to, the Federal Health Insurance Portability and Accountability Act of |
1996, as amended, and 42 CFR Part 2, as amended. The policy shall also require all such attempts |
at notification to 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 use 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 use evaluation, in accordance with best practices standards, before |
discharge; |
(ii) That if, after the completion of a substance-abuse use 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. § 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 peer recovery coaches specialists; 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 certified peer recovery coach specialist 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 use 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. |
(b) Nothing contained in this chapter shall be construed to limit the permitted disclosure |
of confidential health care information and communications permitted in § 5-37.3-4(b)(4)(i) of |
the Confidentiality of Health Care Communications Act confidentiality of health care |
communications act. |
(5) (c) 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) (d) 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. Section 5-37.3-4 of the General Laws in Chapter 5-37.3 entitled |
"Confidentiality of Health Care Communications and Information Act" is hereby amended to read |
as follows: |
5-37.3-4. Limitations on and permitted disclosures. |
(a)(1) Except as provided in subsection (b) of this section, or as specifically provided by |
the law, a patient's confidential health care information shall not be released or transferred |
without the written consent of the patient, or his or her authorized representative, on a consent |
form meeting the requirements of subsection (d) of this section. A copy of any notice used |
pursuant to subsection (d) of this section, and of any signed consent shall, upon request, be |
provided to the patient prior to his or her signing a consent form. Any and all managed care |
entities and managed care contractors writing policies in the state shall be prohibited from |
providing any information related to enrollees that is personal in nature and could reasonably lead |
to identification of an individual and is not essential for the compilation of statistical data related |
to enrollees, to any international, national, regional, or local medical information database. This |
provision shall not restrict or prohibit the transfer of information to the department of health to |
carry out its statutory duties and responsibilities. |
(2) Any person who violates the provisions of this section may be liable for actual and |
punitive damages. |
(3) The court may award a reasonable attorney's fee at its discretion to the prevailing |
party in any civil action under this section. |
(4) Any person who knowingly and intentionally violates the provisions of this section |
shall, upon conviction, be fined not more than five thousand ($5,000) dollars for each violation, |
or imprisoned not more than six (6) months for each violation, or both. |
(5) Any contract or agreement that purports to waive the provisions of this section shall |
be declared null and void as against public policy. |
(b) No consent for release or transfer of confidential health care information shall be |
required in the following situations: |
(1) To a physician, dentist, or other medical personnel who believes, in good faith, that |
the information is necessary for diagnosis or treatment of that individual in a medical or dental |
emergency; |
(2) To medical and dental peer-review boards, or the board of medical licensure and |
discipline, or board of examiners in dentistry; |
(3) To qualified personnel for the purpose of conducting scientific research, management |
audits, financial audits, program evaluations, actuarial, insurance underwriting, or similar studies; |
provided, that personnel shall not identify, directly or indirectly, any individual patient in any |
report of that research, audit, or evaluation, or otherwise disclose patient identities in any manner; |
(4)(i) By a health care provider to appropriate law enforcement personnel, or to a person |
if the health care provider believes that person, or his or her family, is in danger from a patient; or |
to appropriate law enforcement personnel if the patient has, or is attempting to obtain, narcotic |
drugs from the health care provider illegally; or to appropriate law enforcement personnel, or |
appropriate child protective agencies, if the patient is a minor child or the parent or guardian of |
said child and/or the health care provider believes, after providing health care services to the |
patient, that the child is, or has been, physically, psychologically, or sexually abused and |
neglected as reportable pursuant to § 40-11-3; or to appropriate law enforcement personnel or the |
division of elderly affairs if the patient is an elder person and the healthcare provider believes, |
after providing healthcare services to the patient, that the elder person is, or has been, abused, |
neglected, or exploited as reportable pursuant to § 42-66-8; or to law enforcement personnel in |
the case of a gunshot wound reportable under § 11-47-48, or to patient emergency contacts and |
certified peer recovery specialists notified in the case of an opioid overdose reportable under § |
23-17.26-3; |
(ii) A health care provider may disclose protected health information in response to a law |
enforcement official's request for such information for the purpose of identifying or locating a |
suspect, fugitive, material witness, or missing person, provided that the health care provider may |
disclose only the following information: |
(A) Name and address; |
(B) Date and place of birth; |
(C) Social security number; |
(D) ABO blood type and rh RH factor; |
(E) Type of injury; |
(F) Date and time of treatment; |
(G) Date and time of death, if applicable; and |
(H) A description of distinguishing physical characteristics, including height, weight, |
gender, race, hair and eye color, presence or absence of facial hair (beard or moustache), scars, |
and tattoos. |
(I) Except as permitted by this subsection, the health care provider may not disclose for |
the purposes of identification or location under this subsection any protected health information |
related to the patient's DNA or DNA analysis, dental records, or typing, samples, or analysis of |
body fluids or tissue.; |
(iii) A health care provider may disclose protected health information in response to a law |
enforcement official's request for such information about a patient who is, or is suspected to be, a |
victim of a crime, other than disclosures that are subject to subsection (b)(4)(vii) of this section, |
if: |
(A) The patient agrees to the disclosure; or |
(B) The health care provider is unable to obtain the patient's agreement because of |
incapacity or other emergency circumstances provided that: |
(1) The law enforcement official represents that such information is needed to determine |
whether a violation of law by a person other than the victim has occurred, and such information is |
not intended to be used against the victim; |
(2) The law enforcement official represents that immediate law enforcement activity that |
depends upon the disclosure would be materially and adversely affected by waiting until the |
patient is able to agree to the disclosure; and |
(3) The disclosure is in the best interests of the patient as determined by the health care |
provider in the exercise of professional judgment.; |
(iv) A health care provider may disclose protected health information about a patient who |
has died to a law enforcement official for the purpose of alerting law enforcement of the death of |
the patient if the health care provider has a suspicion that such death may have resulted from |
criminal conduct.; |
(v) A health care provider may disclose to a law enforcement official protected health |
information that the health care provider believes in good faith constitutes evidence of criminal |
conduct that occurred on the premises of the health care provider.; |
(vi)(A) A health care provider providing emergency health care in response to a medical |
emergency, other than such emergency on the premises of the covered health care provider, may |
disclose protected health information to a law enforcement official if such disclosure appears |
necessary to alert law enforcement to: |
(1) The commission and nature of a crime; |
(2) The location of such crime or of the victim(s) of such crime; and |
(3) The identity, description, and location of the perpetrator of such crime. |
(B) If a health care provider believes that the medical emergency described in subsection |
(b)(4)(vi)(A) of this section is the result of abuse, neglect, or domestic violence of the individual |
in need of emergency health care, subsection (b)(4)(vi)(A) of this section does not apply and any |
disclosure to a law enforcement official for law enforcement purposes is subject to subsection |
(b)(4)(vii) of this section.; |
(vii)(A) Except for reports permitted by subsection (b)(4)(i) of this section, a health care |
provider may disclose protected health information about a patient the health care provider |
reasonably believes to be a victim of abuse, neglect, or domestic violence to law enforcement or a |
government authority, including a social service or protective services agency, authorized by law |
to receive reports of such abuse, neglect, or domestic violence: |
(1) To the extent the disclosure is required by law and the disclosure complies with, and |
is limited to, the relevant requirements of such law; |
(2) If the patient agrees to the disclosure; or |
(3) To the extent the disclosure is expressly authorized by statute or regulation and: |
(i) The health care provider, in the exercise of professional judgment, believes the |
disclosure is necessary to prevent serious harm to the patient or other potential victims; or |
(ii) If the patient is unable to agree because of incapacity, a law enforcement or other |
public official authorized to receive the report represents that the protected health information for |
which disclosure is sought is not intended to be used against the patient and that an immediate |
enforcement activity that depends upon the disclosure would be materially and adversely affected |
by waiting until the patient is able to agree to the disclosure. |
(B) A health care provider that makes a disclosure permitted by subsection (b)(4)(vii)(A) |
of this section must promptly inform the patient that such a report has been, or will be, made, |
except if: |
(1) The health care facility, in the exercise of professional judgment, believes informing |
the patient would place the individual at risk of serious harm; or |
(2) The health care provider would be informing a personal representative, and the health |
care provider reasonably believes the personal representative is responsible for the abuse, neglect, |
or other injury, and that informing such person would not be in the best interests of the individual |
as determined by the covered entity in the exercise of professional judgment.; |
(viii) The disclosures authorized by this subsection shall be limited to the minimum |
amount of information necessary to accomplish the intended purpose of the release of |
information.; |
(5) Between, or among, qualified personnel and health care providers within the health |
care system for purposes of coordination of health care services given to the patient and for |
purposes of education and training within the same health care facility; or |
(6) To third-party health insurers, including to utilization review agents as provided by § |
23-17.12-9(c)(4), third-party administrators licensed pursuant to chapter 20.7 of title 27, and other |
entities that provide operational support to adjudicate health insurance claims or administer health |
benefits; |
(7) To a malpractice insurance carrier or lawyer if the health care provider has reason to |
anticipate a medical liability action; or |
(8)(i) To the health care provider's own lawyer or medical liability insurance carrier if the |
patient whose information is at issue brings a medical liability action against a health care |
provider. |
(ii) Disclosure by a health care provider of a patient's health care information that is |
relevant to a civil action brought by the patient against any person or persons other than that |
health care provider may occur only under the discovery methods provided by the applicable |
rules of civil procedure (federal or state). This disclosure shall not be through ex parte contacts |
and not through informal ex parte contacts with the provider by persons other than the patient or |
his or her legal representative. |
Nothing in this section shall limit the right of a patient, or his or her attorney, to consult |
with that patient's own physician and to obtain that patient's own health care information; |
(9) To public health authorities in order to carry out their functions as described in this |
title and titles 21 and 23 and rules promulgated under those titles. These functions include, but are |
not restricted to, investigations into the causes of disease, the control of public health hazards, |
enforcement of sanitary laws, investigation of reportable diseases, certification and licensure of |
health professionals and facilities, review of health care such as that required by the federal |
government and other governmental agencies; |
(10) To the state medical examiner in the event of a fatality that comes under his or her |
jurisdiction; |
(11) In relation to information that is directly related to a current claim for workers' |
compensation benefits or to any proceeding before the workers' compensation commission or |
before any court proceeding relating to workers' compensation; |
(12) To the attorneys for a health care provider whenever that provider considers that |
release of information to be necessary in order to receive adequate legal representation; |
(13) By a health care provider to appropriate school authorities of disease, health |
screening, and/or immunization information required by the school; or when a school-age child |
transfers from one school or school district to another school or school district; |
(14) To a law enforcement authority to protect the legal interest of an insurance |
institution, agent, or insurance-support organization in preventing and prosecuting the |
perpetration of fraud upon them; |
(15) To a grand jury, or to a court of competent jurisdiction, pursuant to a subpoena or |
subpoena duces tecum when that information is required for the investigation or prosecution of |
criminal wrongdoing by a health care provider relating to his, her or its provisions of health care |
services and that information is unavailable from any other source; provided, that any information |
so obtained, is not admissible in any criminal proceeding against the patient to whom that |
information pertains; |
(16) To the state board of elections pursuant to a subpoena or subpoena duces tecum |
when that information is required to determine the eligibility of a person to vote by mail ballot |
and/or the legitimacy of a certification by a physician attesting to a voter's illness or disability; |
(17) To certify, pursuant to chapter 20 of title 17, the nature and permanency of a |
person's illness or disability, the date when that person was last examined and that it would be an |
undue hardship for the person to vote at the polls so that the person may obtain a mail ballot; |
(18) To the central cancer registry; |
(19) To the Medicaid fraud control unit of the attorney general's office for the |
investigation or prosecution of criminal or civil wrongdoing by a health care provider relating to |
his, her or its provision of health care services to then-Medicaid-eligible recipients or patients, |
residents, or former patients or residents of long-term residential care facilities; provided, that any |
information obtained shall not be admissible in any criminal proceeding against the patient to |
whom that information pertains; |
(20) To the state department of children, youth and families pertaining to the disclosure |
of health care records of children in the custody of the department; |
(21) To the foster parent, or parents, pertaining to the disclosure of health care records of |
children in the custody of the foster parent, or parents; provided, that the foster parent or parents |
receive appropriate training and have ongoing availability of supervisory assistance in the use of |
sensitive information that may be the source of distress to these children; |
(22) A hospital may release the fact of a patient's admission and a general description of a |
patient's condition to persons representing themselves as relatives or friends of the patient or as a |
representative of the news media. The access to confidential health care information to persons in |
accredited educational programs under appropriate provider supervision shall not be deemed |
subject to release or transfer of that information under subsection (a) of this section; or |
(23) To the workers' compensation fraud prevention unit for purposes of investigation |
under §§ 42-16.1-12 -- 42-16.1-16. The release or transfer of confidential health care information |
under any of the above exceptions is not the basis for any legal liability, civil or criminal, nor |
considered a violation of this chapter; or |
(24) To a probate court of competent jurisdiction, petitioner, respondent, and/or their |
attorneys, when the information is contained within a decision-making assessment tool that |
conforms to the provisions of § 33-15-47. |
(c) Third parties receiving, and retaining, a patient's confidential health care information |
must establish at least the following security procedures: |
(1) Limit authorized access to personally identifiable, confidential health care |
information to persons having a "need to know" that information; additional employees or agents |
may have access to that information that does not contain information from which an individual |
can be identified; |
(2) Identify an individual, or individuals, who have responsibility for maintaining |
security procedures for confidential health care information; |
(3) Provide a written statement to each employee or agent as to the necessity of |
maintaining the security and confidentiality of confidential health care information, and of the |
penalties provided for in this chapter for the unauthorized release, use, or disclosure of this |
information. The receipt of that statement shall be acknowledged by the employee or agent, who |
signs and returns the statement to his or her employer or principal, who retains the signed |
original. The employee or agent shall be furnished with a copy of the signed statement; and |
(4) Take no disciplinary or punitive action against any employee or agent solely for |
bringing evidence of violation of this chapter to the attention of any person. |
(d) Consent forms for the release or transfer of confidential health care information shall |
contain, or in the course of an application or claim for insurance be accompanied by a notice |
containing, the following information in a clear and conspicuous manner: |
(1) A statement of the need for and proposed uses of that information; |
(2) A statement that all information is to be released or clearly indicating the extent of the |
information to be released; and |
(3) A statement that the consent for release or transfer of information may be withdrawn |
at any future time and is subject to revocation, except where an authorization is executed in |
connection with an application for a life or health insurance policy in which case the |
authorization expires two (2) years from the issue date of the insurance policy, and when signed |
in connection with a claim for benefits under any insurance policy, the authorization shall be |
valid during the pendency of that claim. Any revocation shall be transmitted in writing. |
(e) Except as specifically provided by law, an individual's confidential health care |
information shall not be given, sold, transferred, or in any way relayed to any other person not |
specified in the consent form or notice meeting the requirements of subsection (d) of this section |
without first obtaining the individual's additional written consent on a form stating the need for |
the proposed new use of this information or the need for its transfer to another person. |
(f) Nothing contained in this chapter shall be construed to limit the permitted disclosure |
of confidential health care information and communications described in subsection (b) of this |
section. |
SECTION 3. This act shall take effect upon passage. |
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LC000742/SUB A/2 |
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