2018 -- H 7476

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LC004549

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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 -- INSURANCE COVERAGE FOR MENTAL ILLNESS AND

SUBSTANCE ABUSE

     Introduced By: Representatives Serpa, Fellela, Canario, Costantino, and Winfield

     Date Introduced: February 07, 2018

     Referred To: House Health, Education & Welfare

     (Attorney General)

It is enacted by the General Assembly as follows:

     SECTION 1. Section 27-38.2-1 of the General Laws in Chapter 27-38.2 entitled

"Insurance Coverage for Mental Illness and Substance Abuse" is hereby amended to read as

follows:

     27-38.2-1. Coverage for treatment of mental health and substance use disorders.

[Effective April 1, 2018.].

     (a) A group health plan and an individual or group health insurance plan shall provide

coverage for the treatment of mental health and substance-use disorders under the same terms and

conditions as that coverage is provided for other illnesses and diseases.

     (b) Coverage for the treatment of mental health and substance-use disorders shall not

impose any annual or lifetime dollar limitation.

     (c) Financial requirements and quantitative treatment limitations on coverage for the

treatment of mental health and substance-use disorders shall be no more restrictive than the

predominant financial requirements applied to substantially all coverage for medical conditions in

each treatment classification.

     (d) Coverage shall not impose non-quantitative treatment limitations for the treatment of

mental health and substance-use disorders unless the processes, strategies, evidentiary standards,

or other factors used in applying the non-quantitative treatment limitation, as written and in

operation, are comparable to, and are applied no more stringently than, the processes, strategies,

evidentiary standards, or other factors used in applying the limitation with respect to

medical/surgical benefits in the classification.

     (e) The following classifications shall be used to apply the coverage requirements of this

chapter: (1) Inpatient, in-network; (2) Inpatient, out-of-network; (3) Outpatient, in-network; (4)

Outpatient, out-of-network; (5) Emergency care; and (6) Prescription drugs.

     (f) Medication-assisted treatment or medication-assisted maintenance services of

substance-use disorders, opioid overdoses, and chronic addiction, including methadone,

buprenorphine, naltrexone, or other clinically appropriate medications, is included within the

appropriate classification based on the site of the service.

     (g) Payors shall rely upon the criteria of the American Society of Addiction Medicine

when developing coverage for levels of care for substance-use disorder treatment.

     (h) Patients with substance-use disorders shall have access to evidence-based, non-opioid

treatment for pain, therefore coverage shall apply to medically necessary chiropractic care and

osteopathic manipulative treatment performed by an individual licensed under § 5-37-2.

     (i) Consistent with coverage for medical and surgical services, a group health plan or

health insurer shall cover clinically appropriate residential or inpatient services, including

detoxification and stabilization services, for the treatment of mental health and/or substance-

abuse disorders, including alcohol-use disorders, in accordance with this subsection. After an

appropriate psychiatric assessment for mental health, or an assessment for substance-abuse

disorders, including alcohol-use disorders, based upon the criteria of the American Society of

Addiction Medicine, conducted upon an emergency admission or for continuation of care, if a

qualified medical and/or clinical professional determines that residential or inpatient care,

including detoxification and stabilization services, is the most appropriate and least restrictive

level of care necessary, that professional shall, within twenty-four (24) hours of admission or at

least twenty-four (24) hours prior to the expiration of any previous authorization from the group

health plan or health insurer, submit a treatment plan, including an estimated length of stay and

such other information as may be reasonably requested by the group health plan or health insurer,

to the patient’s group health plan or health insurer. The group health plan or health insurer shall

review the information submitted in accordance with the timelines and requirements of chapter

18.9 of title 27; provided, that the patient shall be and remain presumptively covered for

residential or inpatient services, including detoxification and stabilization services, during the

authorization or concurrent assessment review. This subsection shall apply only to covered

services delivered within the group health plan or health insurer’s provider network.

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     SECTION 2. This act shall take effect on January 1, 2019.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE -- INSURANCE COVERAGE FOR MENTAL ILLNESS AND

SUBSTANCE ABUSE

***

     This act would provide that consistent with coverage for medical and surgical services, a

group health plan or health insurer shall cover clinically appropriate residential or inpatient

services, including detoxification and stabilization services, for the treatment of mental health

and/or substance-abuse disorders, including alcohol-use disorders. This act would also provide

that the patient shall be and remain presumptively covered for residential or inpatient services,

including detoxification and stabilization services, during the authorization or concurrent

assessment review by the patient’s group health plan or health insurer.

     This act would take effect January 1, 2019.

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