§ 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) 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 C.F.R. Part 2, as amended. The policy shall also require all 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 subsection (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 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 use
evaluation, in accordance with best practices standards, before discharge;
(ii) That if, after the completion of a substance 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 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 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 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 healthcare 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 healthcare information and communications permitted in § 5-37.3-4(b)(4)(i) of the confidentiality of health care communications act.
(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.
(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 healthcare
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.