2021 -- H 6268

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LC002690

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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 INSURANCE -- COVERAGE FOR MENTAL ILLNESS AND SUBSTANCE

ABUSE

     Introduced By: Representatives Tanzi, Cortvriend, Alzate, Cassar, Giraldo, Felix, Amore,
Potter, Ajello, and Morales

     Date Introduced: April 28, 2021

     Referred To: House Finance

     It is enacted by the General Assembly as follows:

     SECTION 1. Legislative findings.

     The general assembly finds and declares that:

      (1) According to Mental Health America’s 2021 report, fifty thousand (50,000) Rhode

Islanders, or twenty-seven and nine-tenths percent (27.9%) of adults experiencing a mental illness,

reported that they were not able to receive the treatment they needed. Rhode Island has the highest

prevalence of untreated adults with mental illness of any state in New England, and has a higher

prevalence than the national average of twenty-three and sixth-tenths percent (23.6%).

     (2) The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA, or the Act)

and state mental health parity laws require “behavioral healthcare benefits” (benefits for mental

health and substance use disorders) that are covered by most health insurance plans to be treated at

parity with medical/surgical benefits.

     (3) The 2010 Affordable Care Act (ACA) requires coverage of mental health and substance

use services as an “essential health benefit”. The ACA built on the federal Mental Health Parity

and Addiction Equity Act of 2008, which requires many group insurance plans that cover mental

health and substance use services to do so as generously as medical and surgical services.

     (4) In the Milliman research group’s 2019 report, entitled, “Addiction and mental health

vs. physical health: Widening disparities in network use and provider reimbursement,” researchers

demonstrated that in Rhode Island patients were four and twenty-eight hundredths (4.28) times or

four hundred twenty-eight percent (428%) more likely to have to go out of network for a mental

health office visit than for a primary care visit in 2017, which is an increase from two and twenty-

eight hundredths (2.28) times or two hundred twenty-eight percent (228%) in 2013.

     (5) According to the Milliman report, in Rhode Island, mental health professionals received

twenty-three and four-tenths percent (23.4%) less than other specialists for similar billing codes for

the evaluation and management of conditions in 2017.

     (6) The 2015 Truven Health Analytics study, which was done on behalf of the State of

Rhode Island, found that “public financing for behavioral health care for adults and adolescents

dropped from one hundred ten million dollars ($110,000,000) in 2007 to ninety-seven million

dollars ($97,000,000) in 2014. State funding for substance abuse services dropped from about

fifteen million five hundred thousand dollars ($15,500,000) to five million ($5,000,000).”

     (7) Rhode Island increased its primary care investment by nearly forty percent (40%)

between 2008 and 2012, which led to ninety-five percent (95%) of practice sites achieving “medical

home” status, a seven and two-tenths percent (7.2%) reduction in hospital admissions, a five percent

(5%) reduction in costs, and savings of thirty million dollars ($30,000,000).

     (8) An increased investment in behavioral health care services, which includes mental

health and substance use disorder services and treatments, is anticipated to increase access to care

and decrease overall costs to the healthcare system by reducing hospital and inpatient care

admissions much like the investment in primary care described in subsection 7.

     (9) Therefore, the state of Rhode Island reaffirms its commitment to achieving parity and

hereby requires all commercial and public payers to increase their rates of reimbursement for all

in-network behavioral health care services other than inpatient psychiatric hospitalization by twenty

three and four-tenths percent (23.4%) over the next five (5) years by July 1, 2027 by a minimum

of a four percent (4%) increase per year.

     SECTION 2. Chapter 27-38.2 of the General Laws entitled "Insurance Coverage for Mental

Illness and Substance Abuse" is hereby amended by adding thereto the following section:

     27-38.2-6. Reimbursement rate parity for mental health and substance use disorders.

     (a) Every individual or group health insurance contract, plan or policy delivered, issued for

delivery or renewed in this state on or after January 1, 2022, shall increase rates of reimbursement

for all in-network behavioral health care services other than inpatient psychiatric hospitalization by

twenty-three and four-tenths percent (23.4%) over the following five (5) years with a minimum

increase of four percent (4%) per year. The total increase of twenty-three and four-tenths percent

(23.4%) must be completed on or before July 1, 2027.

     (b) Each health insurer shall collect and provide to the office of the health insurance

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commissioner (OHIC), in a form and frequency acceptable to OHIC, information and data

reflecting its increases to reimbursement rates for all in-network behavioral health care services

other than inpatient psychiatric hospitalization as described in subsection (a) of this section.

     (c) On or before July 1, 2023, OHIC, in collaboration with the executive office of health

and human services, shall issue a report to the general assembly. This report shall include

recommendations for an evidence-based rate increase methodology to be applied to all in-network

behavioral health care services other than inpatient psychiatric hospitalization in the years

following 2027. These rate increase methodology recommendations shall take into consideration:

     (1) Reimbursement rates for all in-network behavioral health care services other than

inpatient psychiatric hospitalization in neighboring states, including Connecticut and

Massachusetts;

     (2) The medical consumer price index;

     (3) Outcome-based value metrics; and

     (4) Tying reimbursement rates to the cost of providing in-network behavioral health care

services and treatments.

     (d) OHIC shall monitor how reimbursement rate increases described in this section affect

patient access to behavioral health care services and treatments, including, but not limited to, any

change in the behavioral health care provider workforce. On or before July 1, 2023, and each July

1 thereafter, OHIC shall report any access and workforce changes to the general assembly in

writing.

     (e) On or before July 1, 2027, OHIC shall notify the general assembly in writing when each

health insurer has met their rate increase obligation as described in subsection (a) of this section.

     (f)(1) OHIC shall promulgate such rules and regulations as are necessary and proper to

effectuate the purpose and for the efficient administration and enforcement of this section.

     (2) Should OHIC find that a health insurer is not in compliance with the requirements found

in this section, OHIC’s authority shall include, but not be limited to, requiring a health insurer to

complete a corrective action plan.

     SECTION 3. Chapter 42-7.2 of the General Laws entitled "Office of Health and Human

Services" is hereby amended by adding thereto the following section:

     42-7.2-21. Reimbursement rate parity for mental health and substance use disorder.

     (a) Effective January 1, 2022, Rhode Island Medicaid and its contracted managed care

entities shall increase rates of reimbursement for all in-network behavioral health care services

other than inpatient psychiatric hospitalization by twenty-three and four-tenths percent (23.4%)

over the following five (5) years with a minimum increase of (4%) per year. The total increase of

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twenty-three and four-tenths percent (23.4%) must be completed on or before July 1, 2027.

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

provide the executive office of health and human services (EOHHS), in a form and frequency

acceptable to EOHHS, information and data reflecting its increases to reimbursement rates for all

in-network behavioral health care services other than inpatient psychiatric hospitalization

reimbursement rates as described in subsection (a) of this section.

     (c) On or before July 1, 2023, EOHHS, in collaboration with the office of the health

insurance commissioner, shall issue a report to the general assembly. This report shall include

recommendations for an evidence-based rate increase methodology to be applied to all in-network

behavioral health care services other than inpatient psychiatric hospitalization in the years

following 2027. These rate increase methodology recommendations shall take into consideration:

     (1) Reimbursement rates for all in-network behavioral health care services other than

inpatient psychiatric hospitalization in neighboring states, including Connecticut and

Massachusetts;

     (2) The medical consumer price index;

     (3) Outcome-based value metrics; and

     (4) Tying reimbursement rates to the cost of providing in-network behavioral health care

services and treatments.

     (d) EOHHS shall monitor how reimbursement rate increases described in this section affect

patient access to behavioral health care services and treatments, including, but not limited to, any

change in the behavioral health care provider workforce. On or before July 1, 2023, and each July

1 thereafter, EOHHS shall report any access and workforce changes to the general assembly in

writing.

     (e) On or before July 1, 2027, EOHHS shall notify the general assembly in writing when

each contracted managed care entity has met their rate increase obligation as described in

subsection (a) of this section.

     (f)(1) EOHHS shall promulgate such rules and regulations as are necessary and proper to

effectuate the purpose and for the efficient administration and enforcement of this section.

     (2) Should EOHHS find that Rhode Island Medicaid and its contracted managed care

entities are not in compliance with the requirements found in this section, EOHHS’s authority shall

include, but not be limited to, requiring a contracted manage care entity to complete a corrective

action plan.

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     SECTION 4. 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 -- COVERAGE FOR MENTAL ILLNESS AND SUBSTANCE

ABUSE

***

     This act would increase reimbursement rates for behavioral health providers over a five (5)

year period. The minimum increase per year would be four percent (4%) resulting in a total increase

of twenty-three and four-tenths percent (23.4%).

     This act would take effect upon passage.

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