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 §5-37-2.

SECTION 6. This act shall take effect upon passage on April 1, 2018.

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LC002439/SUB A

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