2022 -- H 7861

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LC005302

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2022

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A N   A C T

RELATING TO INSURANCE -- INSURANCE COVERAGE FOR MENTAL ILLNESS AND

SUBSTANCE ABUSE

     

     Introduced By: Representatives Tanzi, Felix, McGaw, Ajello, Batista, Ranglin-Vassell,
Donovan, Shallcross Smith, Cortvriend, and Kislak

     Date Introduced: March 04, 2022

     Referred To: House Finance

     It is enacted by the General Assembly as follows:

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     SECTION 1. 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, 2023, shall increase the rate of reimbursement

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for each in-network behavioral health care service that is reimbursed below the median commercial

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reimbursement rate set by the office of the health insurance commissioner. The rate will increase

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annually to no less than the median commercial reimbursement rate set by the office of the health

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insurance commissioner on or before July 1, 2028.

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     (1) Median commercial insurance rates for each in-network behavioral health care service

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shall be determined by the office of the health insurance commissioner.

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     (2) For rates lower than the median commercial reimbursement rate, incremental increases

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towards the median commercial reimbursement rate must take place on an annual basis at a rate

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determined by the office of the health insurance commissioner.

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     (3) Reimbursement rates that are at or above the median commercial reimbursement rate

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for an in-network behavioral health care services shall not be decreased by a health insurer.

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     (b) Each health insurer shall collect and provide any information and data to the office of

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the health insurance commissioner in a form and frequency acceptable to the office that is deemed

 

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necessary to uphold the requirements of this section.

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     (c) The office of the health insurance commissioner shall monitor how reimbursement rate

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increases described in this section affect patient access to behavioral health care services, including,

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but not limited to, any changes related to behavioral health network adequacy. On or before July 1,

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2024, and on or before each July 1 thereafter, the office of the health insurance commissioner shall

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report any changes to behavioral health care access and network adequacy to the general assembly

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in writing.

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

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in chapter 18.8 of this title.

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     (d) The office of the health insurance commissioner may promulgate such rules and

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

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and enforcement of this section.

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     (1) Should the office of the health insurance commissioner find that a health insurer is not

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in compliance with the requirements found in this section, the office of the health insurance

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commissioner’s authority shall include, but not be limited to, requiring a health insurer to complete

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a corrective action plan.

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     SECTION 2. 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 disorder.

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     (a) Effective January 1, 2023, Rhode Island Medicaid and its contracted managed care

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entities shall increase the rate of reimbursement for each in-network behavioral health care service

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that is reimbursed below the median commercial reimbursement rate set by the office of the health

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insurance commissioner. The rate will increase annually to no less than the median commercial

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reimbursement rate set by the office of the health insurance commissioner on or before July 1,

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2028.

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     (1) Median commercial insurance rates for each in-network behavioral health care service,

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as determined by the office of the health insurance commissioner in accordance with § 27-38.2-6,

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shall be shared with the executive office of health and human services in accordance with § 42-7.2-

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14.

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     (2) For rates lower than the median commercial reimbursement rate determined in

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accordance with subsection (a)(1) of this section, incremental increases towards the median

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commercial reimbursement rate set by the office of health and human services must take place on

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an annual basis at a rate determined by the executive office of health and human services.

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     (3) Reimbursement rates that are at or above the median commercial reimbursement rate

 

LC005302 - Page 2 of 4

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for an in-network behavioral health care services shall not be decreased by Rhode Island Medicaid

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or its contracted managed care entities.

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

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provide any information and data to the executive office of health and human services in a form

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and frequency acceptable to the office that is deemed necessary to uphold the requirements of this

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section.

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     (c) The executive office of health and human services shall monitor how reimbursement

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rate increases described in this section affect patient access to behavioral health care services

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including, but not limited to, any changes related to behavioral health network adequacy. On or

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before July 1, 2024, and on or before each July 1 thereafter, the executive office of health and

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human services shall report any changes to behavioral health care access and network adequacy to

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the general assembly in writing.

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     (d) The executive office of health and human services is directed to ensure that federal

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financial participation is used to the maximum extent allowable to provide coverage pursuant to

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this section, and that state-only funds will be used only if federal financial participation is not

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available.

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     (e) The executive office of health and human services may promulgate such rules and

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

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and enforcement of this section.

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     (1) Should the executive office of health and human services find that Rhode Island

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Medicaid’s contracted managed care entities are not in compliance with the requirements found in

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this section, the executive office of health and human services authority shall include, but not be

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limited to, requiring a contracted managed care entity to complete a corrective action plan.

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     SECTION 3. 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 the rate of reimbursement for in-network behavioral health care

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services below the medial commercial reimbursement rate. In addition Rhode Island Medicaid shall

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also increase the rate of reimbursement.

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     This act would take effect upon passage.

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LC005302

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