Rules and Regulations for Behavioral Healthcare Organizations

Regulation Authority:

R.I. Gen. Laws § 40.1-1-13(a)(12)
R.I. Gen. Laws § 42-35-1 et seq
R.I. Gen. Laws § 40.1-24-9
R.I. Gen. Laws § 40.1-8.5-7

Purpose and Reason:

By this rulemaking, BHDDH is proposing to:

Amend existing regulations on an emergency basis.  The regulation amendments:

•      Provide clarity to BHOs about staffing configurations for purpose of easing staff shortages and about billing Medicaid at bundled rates for certain staffing.

•      Require BHOs to notify BHDDH in the event of economic Distress and Going Concern Issues, or unplanned staff shortages that usual hiring is not projected to fill.

•      Require LPNs to receive documented supervision by RNs, APRNs or physicians.

•      Require LPNs to work within their clinical expertise and training.

•      Permit certain flexibility in staffing programs with LPNs, RNs, and APRNs as long as certain supervision is provided and that staff act within their scopes of practice.

•      Allow for LPNs to be included in IHH baseline staffing models in BHOs.

•      Allow for LPNs to be included in Assertive Community Treatment (ACT) staffing models in BHOs.

•      Expand the role of LPNs in treatment in Behavioral Health Stabilization Units, inpatient and outpatient Detoxification Units.

•      Expand the role of APRNs in treatment in BHOs of co-occurring mental health and substance use disorders and Behavioral Health Stabilization Units.

•      Require unlicensed residential staff to be supervised by clinical supervisors.

•      Allow Health Home Service to have formal written agreements with regional hospitals and FQHCs in lieu of MOUs.

•      Add or amend definitions of Advanced Practice Registered Nurse (APRN), Licensed Practical Nurses (LPN), Mental Health Professional (MHP), Qualified MHP, Registered Nurse (RN).

Brief statement of Reason for Finding Imminent Peril:

Multiple Rhode Island behavioral healthcare organizations licensed by the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH) have notified BHDDH since the onset of the COVID-19 pandemic in 2020 that they began to experience staff shortages that negatively impacted the provision of behavioral healthcare services, and these staff shortages, which exist not only in Rhode Island but in many areas of the United States, have continued to impact BHOs throughout the duration of the pandemic.  In order to fulfill their statutory and regulatory requirements for staffing and provision of adequate healthcare services, multiple Rhode Island BHOs have requested BHDDH for either variances, waivers or emergency regulations to allow for flexibility in healthcare staffing so that sufficient levels of healthcare are maintained with proper professional supervision.  These emergency regulations establish new and temporary parameters, which are expected to remain in effect as long as the current pandemic is contributing to healthcare staff shortages, of what BHDDH requires for minimal levels of staffing while continuing to meet standards of adequate healthcare required by other BHDDH licensing regulations.