Chapter 165
2017 -- S 0789 SUBSTITUTE A AS AMENDED
Enacted 07/10/2017

A N   A C T
RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

Introduced By: Senators Lombardo, DiPalma, Nesselbush, Lynch Prata, and McCaffrey
Date Introduced: April 25, 2017

It is enacted by the General Assembly as follows:
     SECTION 1. Chapter 27-18 of the General Laws entitled "Accident and Sickness
Insurance Policies" is hereby amended by adding thereto the following section to read as
follows:
     27-18-25. Unfair discrimination prohibited.
     Notwithstanding any provision of any policy of insurance, certificate, or service contract
issued in this state, whenever the insurance policy, certificate, or service contract provides for
reimbursement for any services which that may be legally performed by any person licensed
under the provisions of chapters 29, 30, 35 and 37 of title 5, reimbursement under the insurance
policy, certificate, or service contract shall be based upon a determination of medical necessity
and shall not be denied because of race, color, or creed, nor shall any insurer make or permit any
unfair discrimination against particular individuals or persons licensed under chapters 29, 30, 35
and 37 of title 5.
     SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service
Corporations" is hereby amended by adding thereto the following section:
     27-19-75. Unfair discrimination prohibited.
     Notwithstanding any provision of any policy of insurance, certificate, or service contract
issued in this state, whenever the insurance policy, certificate, or service contract provides for
reimbursement for any services which that may be legally performed by any person licensed
under the provisions of chapters 29, 30, 35 and 37 of title 5, reimbursement under the insurance
policy, certificate, or service contract shall be based upon a determination of medical necessity
and shall not be denied because of race, color, or creed, nor shall any insurer make or permit any
unfair discrimination against particular individuals or persons licensed under chapters 29, 30, 35
and 37 of title 5.
     SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service
Corporations" is hereby amended by adding thereto the following section:
      27-20-71. Unfair discrimination prohibited.
     Notwithstanding any provision of any policy of insurance, certificate, or service contract
issued in this state, whenever the insurance policy, certificate, or service contract provides for
reimbursement for any services which that may be legally performed by any person licensed
under the provisions of chapters 29, 30, 35 and 37 of title 5, reimbursement under the insurance
policy, certificate, or service contract shall be based upon a determination of medical necessity
and shall not be denied because of race, color, or creed, nor shall any insurer make or permit any
unfair discrimination against particular individuals or persons licensed under chapters 29, 30, 35
and 37 of title 5.
     SECTION 4. Chapter 27-41 of the General Laws entitled "Health Maintenance
Organizations" is hereby amended by adding thereto the following section:
     27-41-88. Unfair discrimination prohibited.
     Notwithstanding any provision of any policy of insurance, certificate, or service contract
issued in this state, whenever the insurance policy, certificate, or service contract provides for
reimbursement for any services which that may be legally performed by any person licensed
under the provisions of chapters 29, 30, 35 and 37 of title 5, reimbursement under the insurance
policy, certificate, or service contract shall be based upon a determination of medical necessity
and shall not be denied because of race, color, or creed, nor shall any insurer make or permit any
unfair discrimination against particular individuals or persons licensed under chapters 29, 30, 35
and 37 of title 5.
     SECTION 5. 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 and an individual or group health insurance plan shall provide
coverage for the treatment of mental health and 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 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 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 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 treatment or medication-assisted maintenance services of
substance-use disorders, opioid overdoses, and chronic addiction, including methadone,
buprenorphine, naltrexone, or other clinically appropriate medications, 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.
     (h) Patients with substance-use disorders shall have access to evidence-based, non-opioid
treatment for pain, therefore coverage shall apply to medically necessary chiropractic care, and
osteopathic manipulative treatment performed by an individual licensed under ยง5-37-2.
     SECTION 6. This act shall take effect upon passage on April 1, 2018.
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LC002439/SUB A
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