2021 -- H 5546

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LC001640

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2021

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A N   A C T

RELATING TO INSURANCE - INSURANCE COVERAGE FOR MENTAL ILLNESS AND

SUBSTANCE ABUSE

     

     Introduced By: Representative Robert E. Craven

     Date Introduced: February 12, 2021

     Referred To: House Health & Human Services

     It is enacted by the General Assembly as follows:

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     SECTION 1. The general assembly finds and declares that:

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     (1) Mental Health America's 2021 report, the state of mental health in America, finds that

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the ratio of mental health providers to patients in Rhode Island is 240:1 and the ratio in

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Massachusetts is 160:1.

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     (2) According to Mental Health America's 2021 report, fifty thousand (50,000) Rhode

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Islanders, or twenty-seven and nine-tenths percent (27.9%) of adults experiencing a mental illness,

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reported that they were not able to receive the treatment they needed. Rhode Island has the highest

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prevalence of untreated adults with mental illness of any state in New England, and has a higher

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prevalence than the national average of twenty-three and six-tenths percent (23.6%).

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     (3) The Mental Health Parity and Addiction Equity Act of 2008 ("MHPAEA" or "the Act")

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and state mental health parity laws require "behavioral healthcare benefits" (benefits for mental

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health and substance use disorders) that are covered by most health insurance plans to be treated at

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parity with medical/surgical benefits.

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     (4) The 2010 Affordable Care Act (ACA) requires coverage of mental health and substance

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use services as an "essential health benefit". The ACA built on the federal Mental Health Parity

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and Addiction Equity Act of 2008, which requires many group insurance plans that cover mental

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health and substance use services to do so as generously as medical and surgical services.

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     (5) In the Milliman research group's 2019 report, entitled, "Addiction and mental health vs.

 

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physical health: Widening disparities in network use and provider reimbursement", researchers

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demonstrated that in Rhode Island patients were four and twenty-eight hundredths (4.28) times

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more likely to have to go out of network for a mental health office visit than for a primary care visit

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in 2017, which is an increase from two and twenty-eight hundredths (2.28) times in 2013.

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     (6) According to the Milliman report, in Rhode Island, mental health professionals received

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twenty-three and four-tenths percent (23.4%) less than other specialists for similar billing codes for

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the evaluation and management of conditions in 2017.

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     (7) The 2015 Truven Health Analytics study, which was done on behalf of the state of

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Rhode Island, found that "public financing for behavioral health care for adults and adolescents

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dropped from one hundred ten million dollars ($110,000,000) in 2007 to ninety-seven million

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dollars ($97,000,000) in 2014. State funding for substance abuse services dropped from about

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fifteen million five hundred thousand dollars ($15,500,000) to five million dollars ($5,000,000)."

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     (8) Rhode Island increased its primary care investment by nearly forty percent (40%)

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between 2008 and 2012, which led to ninety-five percent (95%) of practice sites achieving "medical

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home" status, a seven and two-tenths percent (7.2%) reduction in hospital admissions, a five percent

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(5%) reduction in costs, and savings of thirty million dollars ($30,000,000).

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     (9) Therefore, the state of Rhode Island reaffirms its commitment to achieving parity and

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hereby requires all commercial and public payers to increase their rates of reimbursement for

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general outpatient behavioral health services and treatment by twenty three and four-tenths percent

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(23.4%) over the next five (5) years by July 1, 2027 by a minimum of a four percent (4%) increase

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per year.

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     SECTION 2. Chapter 27-38.2 of the General Laws entitled "Insurance Coverage for Mental

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Illness and Substance Abuse" is hereby amended by adding thereto the following section:

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     27-38.2-6. Reimbursement rate parity for mental health and substance use disorders.

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     (a) Every individual or group health insurance contract, plan or policy delivered, issued for

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delivery or renewed in this state on or after January 1, 2022, shall increase rates of reimbursement

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for outpatient, in-network mental health and substance use disorder services and treatments by

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twenty-three and four-tenths percent (23.4%) over the following five (5) years with a minimum

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increase of four percent (4%) per year. The total increase of twenty-three and four-tenths percent

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(23.4%) must be completed on or before July 1, 2027.

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     (b) Each health insurer shall collect and provide to the office of the health insurance

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commissioner (OHIC), in a form and frequency acceptable to OHIC, information and data

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reflecting its increases to outpatient, in-network mental health and substance use disorder

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reimbursement rates as described in subsection (a) of this section.

 

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     (c) On or before July 1, 2025, OHIC, in collaboration with the executive office of health

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and human services (EOHHS), shall issue a report to the general assembly. This report shall include

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recommendations for an evidence-based rate increase methodology to be applied to outpatient, in-

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network mental health and substance use disorder services and treatments in the years following

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2027. These recommendations shall take into consideration reimbursement rates for outpatient, in-

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network mental health and substance use disorders and treatments in neighboring states, including

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Connecticut and Massachusetts.

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     (d) On or before July 1, 2027, OHIC shall notify the general assembly in writing when each

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health insurer has met their rate increase obligation as described in subsection (a) of this section.

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     (e) The health insurance commissioner shall promulgate such rules and regulations as are

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necessary and proper to effectuate the purpose and for the efficient administration and enforcement

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of this section.

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     SECTION 3. Chapter 42-7.2 of the General Laws entitled "Office of Health and Human

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

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     42-7.2-21. Reimbursement rate parity for mental health and substance use disorders.

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     (a) Effective January 1, 2022, Rhode Island Medicaid and its contracted managed care

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entities shall increase rates of reimbursement for outpatient, in-network mental health and

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substance use disorder services and treatments by twenty-three and four-tenths percent (23.4%)

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over the following five (5) years with a minimum increase of four percent (4%) per year. The total

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increase of twenty-three and four-tenths percent (23.4%) must be completed on or before July 1,

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2027.

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     (b) Each of Rhode Island Medicaid's contracted managed care entities shall collect and

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provide the executive office of health and human services (EOHHS), in a form and frequency

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acceptable to EOHHS, information and data reflecting its increases to outpatient, in-network mental

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health and substance use disorder reimbursement rates as described in subsection (a) of this section.

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     (c) On or before July 1, 2025, EOHHS, in collaboration with the office of the health

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insurance commissioner (OHIC), shall issue a report to the general assembly. This report shall

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include recommendations for an evidence-based rate increase methodology to be applied to

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outpatient, in-network mental health and substance use disorder services and treatments in the years

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following 2027. These recommendations shall take into consideration reimbursement rates for

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outpatient, in-network mental health and substance use disorders and treatments in neighboring

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states, including Connecticut and Massachusetts.

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     (d) On or before July 1, 2027, EOHHS shall notify the general assembly in writing when

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each contracted managed care entity has met their rate increase obligation as described in

 

LC001640 - Page 3 of 5

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subsection (a) of this section.

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     (e) The secretary of health and human services shall promulgate such rules and regulations

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as are necessary and proper to effectuate the purpose and for the efficient administration and

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enforcement of this section.

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      SECTION 4. 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 - INSURANCE COVERAGE FOR MENTAL ILLNESS AND

SUBSTANCE ABUSE

***

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     This act would increase reimbursement rates for behavioral health providers over a five (5)

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year period. The minimum increase per year would be four percent (4%) for a total increase of

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twenty-three and four tenths percent (23.4%).

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     This act would take effect upon passage.

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LC001640

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