| Chapter 236 |
| 2015 -- H 5837 SUBSTITUTE A Enacted 07/10/2015 |
| A N A C T |
| RELATING TO INSURANCE - INSURANCE COVERAGE FOR MENTAL ILLNESS AND SUBSTANCE ABUSE |
| Introduced By: Representatives Serpa, Palangio, Fellela, Melo, and McNamara |
| Date Introduced: March 11, 2015 |
| It is enacted by the General Assembly as follows: |
| SECTION 1. 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 the treatment of mental health and substance use disorders. |
| -- (a) A group health plan, plan and an individual or group health insurance plan shall provide |
| coverage for the treatment of mental health and substance use 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 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 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 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 therapy, including methadone maintenance services, for the |
| treatment of substance use substance-use disorders, opioid overdoses, and chronic addiction 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. |
| SECTION 2. This act shall take effect upon passage. |
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| LC002069/SUB A |
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