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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 -- COVERAGE FOR MENTAL ILLNESS AND SUBSTANCE

ABUSE

     Introduced By: Senators Miller, Lawson, DiPalma, DiMario, Valverde, Archambault,
and Bell

     Date Introduced: March 11, 2021

     Referred To: Senate Health & Human Services

     It is enacted by the General Assembly as follows:

     SECTION 1. Legislative findings.

     The general assembly finds and declares that:

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

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

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

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

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

     (2) The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA, or the Act)

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

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

parity with medical/surgical benefits.

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

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

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

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

     (4) In the Milliman research group’s 2019 report, entitled, “Addiction and mental health

vs. physical health: Widening disparities in network use and provider reimbursement,” researchers

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

four hundred twenty-eight percent (428%) more likely to have to go out of network for a mental

health office visit than for a primary care visit in 2017, which is an increase from two and twenty-

eight hundredths (2.28) times or two hundred twenty-eight percent (228%) in 2013.

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

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

the evaluation and management of conditions in 2017.

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

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

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

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

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

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

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

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

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

     (8) An increased investment in behavioral health care services, which includes mental

health and substance use disorder services and treatments, is anticipated to increase access to care

and decrease overall costs to the healthcare system by reducing hospital and inpatient care

admissions much like the investment in primary care described in subsection 7.

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

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

in-network behavioral health care services other than inpatient psychiatric hospitalization by twenty

three and four-tenths percent (23.4%) over the next five (5) years by July 1, 2027 by a minimum

of a four percent (4%) increase per year.

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

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

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

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

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

for each in-network behavioral health care service other than inpatient psychiatric hospitalization

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

with a minimum increase in the first year of three and two-tenths percent (3.2%), and a minimum

increase of four and five-tenths percent (4.5%) each year thereafter. The total minimum increase of

twenty-three and four-tenths percent (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

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

reflecting its increases to reimbursement rates for each in-network behavioral health care service,

other than inpatient psychiatric hospitalization as described in subsection (a) of this section.

     (c)(1) On or before July 1, 2022, OHIC, in collaboration with the executive office of health

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

recommendations for evidence-based rate increases to be applied to in-network behavioral health

care services. The goal of these rate increase recommendations shall be to increase patient access

to behavioral health care services by promoting behavioral health provider recruitment and

retention.

     (2) This report shall include a justified cost estimate to implement such rate increase

recommendations.

     (d)(1) OHIC shall monitor how reimbursement rate increases described in this section

affect patient access to behavioral health care services, including, but not limited to, any changes

related to behavioral health network adequacy. On or before July 1, 2023, and each July 1 thereafter,

OHIC shall report any changes to behavioral health care access and network adequacy to the

general assembly in writing.

     (2) "Network", as used in this section, shall have the same meaning as is defined and used

in chapter 18.8 of this title.

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

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

     (f)(1) OHIC shall promulgate such rules and regulations as are necessary and proper to

effectuate the purpose and for the efficient administration and enforcement of this section.

     (2) Should OHIC find that a health insurer is not in compliance with the requirements found

in this section, OHIC’s authority shall include, but not be limited to, requiring a health insurer to

complete a corrective action plan.

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

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

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

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

entities shall increase rates of reimbursement for each in-network behavioral health care service,

other than inpatient psychiatric hospitalization, by a minimum of twenty-three and four-tenths

percent (23.4%) over the following five (5) years, with a minimum increase in the first year of three

and two-tenths percent (3.2%), and a minimum increase of four and five-tenths percent (4.5%) each

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year thereafter. The total minimum increase of twenty-three and four-tenths percent (23.4%) must

be completed on or before July 1, 2027.

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

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

acceptable to EOHHS, information and data reflecting its increases to reimbursement rates for each

in-network behavioral health care service, other than inpatient psychiatric hospitalization

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

     (c)(1) On or before July 1, 2022, EOHHS, in collaboration with the office of the health

insurance commissioner, shall issue a report to the general assembly. This report shall include

recommendations for evidence-based rate increases to be applied to each in-network behavioral

health care services. The goal of these rate increase recommendations shall be to increase patient

access to behavioral health care services by promoting behavioral health provider recruitment and

retention.

     (2) This report shall include a justified cost estimate to implement such rate increase

recommendations.

     (d)(1) EOHHS shall monitor how reimbursement rate increases described in this section

affect patient access to behavioral health care services, including, but not limited to, any changes

related to behavioral health network adequacy. On or before July 1, 2023, and each July 1 thereafter,

EOHHS shall report any changes to behavioral health care access and network adequacy to the

general assembly in writing.

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

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

subsection (a) of this section.

     (f)(1) EOHHS shall promulgate such rules and regulations as are necessary and proper to

effectuate the purpose and for the efficient administration and enforcement of this section.

     (2) Should EOHHS find that Rhode Island Medicaid and its contracted managed care

entities are not in compliance with the requirements found in this section, EOHHS’s authority shall

include, but not be limited to, requiring a contracted manage care entity to complete a corrective

action plan.

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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 -- COVERAGE FOR MENTAL ILLNESS AND SUBSTANCE

ABUSE

***

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

year period. The minimum increase of twenty-three and four-tenths percent (23.4%) over the

following five (5) years, with a minimum increase in the first year of three and two-tenths percent

(3.2%), and a minimum increase of four and five-tenths percent (4.5%) each year thereafter.

     This act would take effect upon passage.

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