2021 -- S 0769 | |
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LC000353 | |
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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 HEALTH AND SAFETY - COMPREHENSIVE DISCHARGE PLANNING | |
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Introduced By: Senators Miller, Lawson, Goodwin, Goldin, Calkin, Bell, Kallman, and | |
Date Introduced: April 01, 2021 | |
Referred To: Senate Health & Human Services | |
It is enacted by the General Assembly as follows: | |
1 | SECTION 1. Chapter 23-17.26 of the General Laws entitled "Comprehensive Discharge |
2 | Planning" is hereby amended by adding thereto the following section: |
3 | 23-17.26-3.1. Comprehensive patient consent form. |
4 | Each hospital and freestanding emergency-care facility shall incorporate patient consent |
5 | for certified peer recovery specialist services into a comprehensive patient consent form to be |
6 | implemented no later than January 1, 2022. |
7 | SECTION 2. Section 27-38.2-1 of the General Laws in Chapter 27-38.2 entitled "Insurance |
8 | Coverage for Mental Illness and Substance Abuse" is hereby amended to read as follows: |
9 | 27-38.2-1. Coverage for treatment of mental health and substance use disorders. |
10 | (a) A group health plan and an individual or group health insurance plan, and any contract |
11 | between the Rhode Island Medicaid program and any health insurance carrier, as defined under |
12 | chapters 18, 19, 20, and 41 of title 27, shall provide coverage for the treatment of mental-health |
13 | and substance-use disorders under the same terms and conditions as that coverage is provided for |
14 | other illnesses and diseases. |
15 | (b) Coverage for the treatment of mental-health and substance-use disorders shall not |
16 | impose any annual or lifetime dollar limitation. |
17 | (c) Financial requirements and quantitative treatment limitations on coverage for the |
18 | treatment of mental-health and substance-use disorders shall be no more restrictive than the |
19 | predominant financial requirements applied to substantially all coverage for medical conditions in |
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1 | each treatment classification. |
2 | (d) Coverage shall not impose non-quantitative treatment limitations for the treatment of |
3 | mental health and substance-use disorders unless the processes, strategies, evidentiary standards, |
4 | or other factors used in applying the non-quantitative treatment limitation, as written and in |
5 | operation, are comparable to, and are applied no more stringently than, the processes, strategies, |
6 | evidentiary standards, or other factors used in applying the limitation with respect to |
7 | medical/surgical benefits in the classification. |
8 | (e) The following classifications shall be used to apply the coverage requirements of this |
9 | chapter: (1) Inpatient, in-network; (2) Inpatient, out-of-network; (3) Outpatient, in-network; (4) |
10 | Outpatient, out-of-network; (5) Emergency care; and (6) Prescription drugs. |
11 | (f) Medication-assisted treatment or medication-assisted maintenance services of |
12 | substance-use disorders, opioid overdoses, and chronic addiction, including methadone, |
13 | buprenorphine, naltrexone, or other clinically appropriate medications, is included within the |
14 | appropriate classification based on the site of the service. |
15 | (g) Payors shall rely upon the criteria of the American Society of Addiction Medicine when |
16 | developing coverage for levels of care and determining placements for substance-use disorder |
17 | treatment. |
18 | (h) Patients with substance-use disorders shall have access to evidence-based, non-opioid |
19 | treatment for pain, therefore coverage shall apply to medically necessary chiropractic care and |
20 | osteopathic manipulative treatment performed by an individual licensed under ยง 5-37-2. |
21 | (i) Parity of cost-sharing requirements. Regardless of the professional license of the |
22 | provider of care, if that care is consistent with the provider's scope of practice and the health plan's |
23 | credentialing and contracting provisions, cost-sharing for behavioral health counseling visits and |
24 | medication maintenance visits shall be consistent with the cost-sharing applied to primary care |
25 | office visits. |
26 | (j) Consistent with coverage for medical and surgical services, a health plan as defined in |
27 | subsection (a) of this section shall cover clinically appropriate residential or inpatient services, |
28 | including detoxification and stabilization services, for the treatment of mental health and substance |
29 | use disorders, including alcohol use disorders, in accordance with this subsection. After an |
30 | assessment for substance use disorders, including alcohol use disorders, based upon the criteria of |
31 | the American Society of Addiction Medicine, or after an appropriate psychiatric assessment for |
32 | mental health disorders, conducted upon an emergency admission or for continuation of care, if a |
33 | qualified medical or clinical professional determines that residential or inpatient care, including |
34 | detoxification and stabilization services, is the most appropriate and least restrictive level of care |
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1 | necessary, that professional shall, within twenty-four (24) hours of admission or at least twenty- |
2 | four (24) hours prior to the expiration of any previous authorization from the health insurer, submit |
3 | a treatment plan, including an estimated length of stay and such other information as may be |
4 | reasonably requested by the health insurer, to the patient's health insurer. The health insurer shall |
5 | conduct the utilization review in accordance with chapter 18.9 of title 27; provided, that the patient |
6 | shall be and remain presumptively covered for residential or inpatient services, including |
7 | detoxification and stabilization services, during the utilization review. On or before March l, 2024, |
8 | the senate committee on health and human services, in conjunction with the house committee on |
9 | corporations, shall conduct a hearing on the impact of this subsection, to include presentations from |
10 | payors and providers, and other stakeholders at the discretion of the committee chairs. This |
11 | subsection shall apply only to covered services delivered within the health insurer's provider |
12 | network. Nothing herein prohibits the group health plan or health insurer from conducting quality |
13 | of care reviews. |
14 | SECTION 3. This act shall take effect on January 1, 2022. |
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EXPLANATION | |
BY THE LEGISLATIVE COUNCIL | |
OF | |
A N A C T | |
RELATING TO HEALTH AND SAFETY - COMPREHENSIVE DISCHARGE PLANNING | |
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1 | This act would require each hospital and freestanding emergency-care facility to |
2 | incorporate consent for certified peer recovery specialist services into a comprehensive patient |
3 | consent form, and further requires all contracts between health insurance carriers and the Rhode |
4 | Island Medicaid program to cover clinically appropriate services for the treatment of mental health |
5 | and substance abuse disorders. |
6 | This act would take effect on January 1, 2022. |
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