2018 -- H 7061

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LC003167

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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 INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

     

     Introduced By: Representatives Craven, McEntee, and Lombardi

     Date Introduced: January 03, 2018

     Referred To: House Finance

     It is enacted by the General Assembly as follows:

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     SECTION 1. Chapter 27-18 of the General Laws entitled "Accident and Sickness

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Insurance Policies" is hereby amended by adding thereto the following section:

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     27-18-48.2. Prospective reimbursement - State contracts.

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     Any contract between the state of Rhode Island and any health insurance carrier, as

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defined under chapters 18, 19, 20, and 41 of title 27, shall require the health insurance carrier to

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pay a state-licensed facility that provides mental health, substance abuse treatment and/or

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prevention services on a prospective basis. Payment on a prospective basis shall require payment

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by the health insurance carrier on the first business day of each month with each payment amount

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equal to the average monthly payment during the immediately preceding calendar year. The

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facility and the health insurance carrier shall undertake a reconciliation within thirty (30) days of

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the close of each calendar year with any overpayment repaid by the facility or underpayment paid

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by the health insurance carrier within ninety (90) days of the close of the calendar year.

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     SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service

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Corporations" is hereby amended by adding thereto the following section:

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     27-19-40.2. Prospective reimbursement - State contracts.

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     Any contract between the state of Rhode Island and any health insurance carrier, as

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defined under chapters 18, 19, 20, and 41 of title 27, shall require the health insurance carrier to

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pay a state-licensed facility that provides mental health, substance abuse treatment and/or

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prevention services on a prospective basis. Payment on a prospective basis shall require payment

 

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by the health insurance carrier on the first business day of each month with each payment amount

2

equal to the average monthly payment during the immediately preceding calendar year. The

3

facility and the health insurance carrier shall undertake a reconciliation within thirty (30) days of

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the close of each calendar year with any overpayment repaid by the facility or underpayment paid

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by the health insurance carrier within ninety (90) days of the close of the calendar year.

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     SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service

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Corporations" is hereby amended by adding thereto the following section:

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     27-20-35.2. Prospective reimbursement - State contracts.

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     Any contract between the state of Rhode Island and any health insurance carrier, as

10

defined under chapters 18, 19, 20, and 41 of title 27, shall require the health insurance carrier to

11

pay a state-licensed facility that provides mental health, substance abuse treatment and/or

12

prevention services on a prospective basis. Payment on a prospective basis shall require payment

13

by the health insurance carrier on the first business day of each month with each payment amount

14

equal to the average monthly payment during the immediately preceding calendar year. The

15

facility and the health insurance carrier shall undertake a reconciliation within thirty (30) days of

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the close of each calendar year with any overpayment repaid by the facility or underpayment paid

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by the health insurance carrier within ninety (90) days of the close of the calendar year.

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     SECTION 4. Chapter 27-41 of the General Laws entitled "Health Maintenance

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Organizations" is hereby amended by adding thereto the following section:

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     27-41-49.2. Prospective reimbursement - State contracts.

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     Any contract between the state of Rhode Island and any health insurance carrier, as

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defined under chapters 18, 19, 20, and 41 of title 27, shall require the health insurance carrier to

23

pay a state-licensed facility that provides mental health, substance abuse treatment and/or

24

prevention services on a prospective basis. Payment on a prospective basis shall require payment

25

by the health insurance carrier on the first business day of each month with each payment amount

26

equal to the average monthly payment during the immediately preceding calendar year. The

27

facility and the health insurance carrier shall undertake a reconciliation within thirty (30) days of

28

the close of each calendar year with any overpayment repaid by the facility or underpayment paid

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by the health insurance carrier within ninety (90) days of the close of the calendar year.

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     SECTION 5. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

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     This act would require prospective reimbursement for state-licensed facilities providing

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mental health, substance abuse treatment and/or prevention services with an annual reconciliation

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for any underpayment or overpayment.

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     This act would take effect upon passage.

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LC003167

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LC003167 - Page 3 of 3