2019 -- H 5120

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2019

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A N   A C T

RELATING TO INSURANCE - ACCIDENT AND SICKNESS INSURANCE POLICIES

     Introduced By: Representatives Morin, Phillips, Casey, Vella-Wilkinson, and Millea

     Date Introduced: January 11, 2019

     Referred To: House Health, Education & Welfare

     It is enacted by the General Assembly as follows:

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

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

     27-18-85. Coverage for physical therapy, occupational therapy, massage therapy,

and the healing art of acupuncture and oriental medicine.

     Every individual or group health insurance contract, plan, or policy contract delivered,

issued for delivery, or renewed in this state on or after January 1, 2020, shall provide coverage for

physical therapy performed by an individual licensed under chapter 40 of title 5, occupational

therapy performed by an individual licensed under chapter 40 of title 5, massage therapy

performed by an individual licensed under chapter 20.8 of title 23, and the healing art of

acupuncture and oriental medicine performed by an individual licensed under chapter 37.2 of title

5.

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

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

     27-19-77. Coverage for physical therapy, occupational therapy, massage therapy,

and the healing art of acupuncture and oriental medicine.

     Every individual or group health insurance contract, plan, or policy contract delivered,

issued for delivery, or renewed in this state on or after January 1, 2020, shall provide coverage for

physical therapy performed by an individual licensed under chapter 40 of title 5, occupational

therapy performed by an individual licensed under chapter 40.1 of title 5, massage therapy

performed by an individual licensed under chapter 20.8 of title 23, and the healing art of

acupuncture and oriental medicine performed by an individual licensed under chapter 37.2 of title

5.

     SECTION 3. 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.

     (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 and coverage shall apply to medically necessary chiropractic care

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

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physical therapy performed by an individual licensed under chapter 40 of title 5, occupational

therapy performed by an individual licensed under chapter 40.1 of title 5, massage therapy

performed by an individual licensed under chapter 20.8 of title 23, and the healing art of

acupuncture and oriental medicine performed by an individual licensed under chapter 37.2 of title

5.

     (i) Parity of cost-sharing requirements. Regardless of the professional license of the

provider of care, if that care is consistent with the provider's scope of practice and the health

plan's credentialing and contracting provisions, cost-sharing for behavioral health counseling

visits and medication maintenance visits shall be consistent with the cost-sharing applied to

primary care office visits.

     SECTION 4. This act shall take effect on January 1, 2020,

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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 health insurance contract plans or policies to provide coverage for

certain licensed practices including physical therapy, occupational therapy, massage therapy,

acupuncture and oriental medicine and would consider such licensed practices as "evidence

based, non-opioid treatments for pain."

     This act would take effect on January 1, 2020.

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