2018 -- S 2546 SUBSTITUTE A

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LC004813/SUB A

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2018

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A N   A C T

RELATING TO HEALTH AND SAFETY - COMPREHENSIVE DISCHARGE PLANNING

     Introduced By: Senators Miller, Goldin, Calkin, Satchell, and Morgan

     Date Introduced: March 01, 2018

     Referred To: Senate Health & Human Services

     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 certified peer recovery specialist 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. § 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

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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 peer recovery 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 recovery coach certified peer recovery

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 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;

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     (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 On or before September, 2018,

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.

     (7) On or before January 1, 2019, the director of the department of health, with the

director of the department of behavioral healthcare, developmental disabilities, and hospitals,

shall develop and implement a program to offer financial incentives to hospitals and freestanding

emergency care facilities operating in the state of Rhode Island that achieve Level 1 certification

in the levels of care for Rhode Island emergency departments and hospitals for treating overdose

and opioid use disorder.

     (8) On or before September 1, 2018, each hospital and freestanding emergency care

facility shall incorporate patient consent for certified peer recovery specialist services into a

comprehensive patient consent form.

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     SECTION 2. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO HEALTH AND SAFETY - COMPREHENSIVE DISCHARGE PLANNING

***

     This act would require the directors of the department of health and behavioral

healthcare, developmental disabilities and hospitals to develop and implement a program to offer

financial incentives to hospitals and emergency facilities that achieve Level 1 certification in

level of care for treating overdose and opioid use disorder.

     This act would take effect upon passage.

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