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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