On June 28, 2016, Rhode Island Governor Gina Raimondo signed a series of bills to address opioid misuse and abuse in the state. Rhode Island is the most recent New England State to pass such legislation this year; the regional trend began in Massachusetts when Governor Baker signed omnibus legislation back in March. A summary of Rhode Island’s legislation follows:
- Opioid Prescribing Limits: Chapters 180 and 199 of the 2016 Public Laws authorizes the Director of the Department of Health to promulgate regulations limiting opioid prescriptions for acute pain. The regulations must limit initial opioid prescriptions for adults to a no more than 30 morphine milligram equivalents daily and no more than a total of 20 doses. The Department of Health must determine an appropriate maximum for pediatric populations. Exemptions apply for chronic pain, palliative care, nursing home care, and cancer pain.
- Substance Use Disorder Treatment Standards: Chapters 172 and 189 of the 2016 Public Laws require the Department of Health to develop regulatory standards for substance abuse disorder evaluation and treatment. By January 2018, the Department of Health must also develop a strategy to maintain a real-time database of inpatient and outpatient services available to individuals needing substance use treatment.
- Insurance Mandates: Chapters 172 and 189 of the 2016 Public Laws expands language requiring health plans to provide substance use disorder treatment to explicitly cover medication-assisted treatment services including buprenorphine, naltrexone, and other clinically appropriate medications. Previously, the law only specified coverage for methadone maintenance services.
Additionally, effective January 1, 2017, Chapters 175 and 192 of the 2016 Public Laws require commercial health plans to provide coverage for at least one generic opioid antagonist and device approved to treat opioid overdose (e.g., naloxone). Health plans may require prior authorization for non-generic versions. This law also clarifies that coverage includes opioid antagonists prescribed or dispensed via standing order or collaborative practice agreement when intended for use on individuals other than the insured.
- Prescription Drug Monitoring Program: Chapters 180 and 199 of the 2016 Public Laws require prescribers to review the prescription drug monitoring program prior to beginning an opioid regimen and every three months thereafter during continuous opioid treatment. When dispensing opioids, pharmacies are required to report the dispensing within one business day. Chapters 180 and 199 also automate prescribers’ registration in the state’s prescription drug monitoring program.
Additionally, Chapter 200 of the 2016 Public Laws requires the Department of Health to “improve the usefulness and value of the prescription drug monitoring database program.” The law provided specific examples of ways in which the department may improve the program, including utilizing information from additional data sources and automatically alerting providers to suspicious activity. Chapter 194 of the 2016 Public Laws expands access to the database to vendors, agents, contractors, and other designees who operate an electronic medical record or clinical management system.
Chapters 181 and 195 of the 2016 Public Laws expand the prescription drug monitoring program to include Schedule V Controlled Substances (which includes cough preparations containing limited quantities of narcotics).
- Auricular Acudetox Licensing: Chapters 183 and 187 of the 2016 Public Laws establishes licensing requirements for individuals performing auricular acudetox (i.e. acupuncture detoxification). Individuals licensed to provide auricular acudetox are not allowed to perform acupuncture outside the scope of auricular acudetox or represent themselves as an acupuncture professional.