2024 -- S 2610

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LC004833

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2024

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A N   A C T

RELATING TO INSURANCE -- MENTAL HEALTH SERVICE PROVIDER

COMPENSATION ACT

     Introduced By: Senators Bell, Ujifusa, DiMario, Mack, and Murray

     Date Introduced: March 01, 2024

     Referred To: Senate Health & Human Services

     It is enacted by the General Assembly as follows:

     SECTION 1. Title 27 of the General Laws entitled "INSURANCE" is hereby amended by

adding thereto the following chapter:

CHAPTER 38.3

MENTAL HEALTH SERVICE PROVIDER COMPENSATION ACT

     27-38.3-1. Short title.

     This chapter shall be known and may be cited as the "Mental Health Service Provider

Compensation Act."

     27-38.3-2. Goals and purpose.

     The goals and purpose of this chapter are to:

     (1) Establish a robust and effective regulatory system of oversight and enforcement for

insurance reimbursement to mental health care service providers for services rendered to patients.

     (2) Expand mental health care service availability for insured individuals by setting a

reimbursement rate structure that encourages mental health professionals to accept insurance

reimbursement for services rendered.

     (3) Minimize, if not eliminate, the private-pay market for mental health treatment or care

by regulating insurance reimbursement rates and setting a reasonable floor rate determined by

regional market rates in order that mental health care professionals have no financial incentive to

refuse mental health patient care to insured individuals due to inadequate reimbursement rates.

     27-38.3-3. Definitions.

     For purposes of this chapter, the following words and terms shall have the following

meanings:

     (1) "Commissioner" means the health insurance commissioner appointed pursuant to the

provisions of § 42-14.5-3.

     (2) "Domestic health insurer" means any entity subject to the insurance laws and

regulations of this state, or subject to the jurisdiction of the health insurance commissioner, that

contracts or offers to contract, to provide and/or insuring health services on a prepaid basis,

including, but not limited to, policies of accident and sickness insurance subject to chapter 18 of

title 27; any nonprofit hospital service corporation subject to chapter 19 of title 27; any nonprofit

medical service corporation subject to chapter 20 of title 27; any health maintenance organization

subject to chapter 41 of title 27; or any health benefit plan issued by the State of Rhode Island, a

municipality, a quasi-public agency, or any other political subdivision of the State of Rhode Island

to cover employees, retirees, or the dependents thereof. A domestic health insurer shall be construed

to include any pharmacy benefit manager or other entity that subcontracts with it.

     (3) "Health insurer" means any domestic health insurer and any plan that provides benefits

consisting of medical care (provided directly, through insurance or reimbursement, or otherwise

and including items and services paid for as medical care), except Medicaid plans and managed

care organizations, Medicare plans, and any plan that the health insurance commissioner shall

determine to be federally preempted from state regulation over the rates paid to providers. The

health insurance commissioner may provisionally designate a plan as exempt from the definition

of a health insurer in order to study whether it is federally preempted from state regulation over the

rates paid to providers. A health insurer shall be construed to include any pharmacy benefit manager

or other entity that subcontracts with it.

     (4) "Mental health professional" shall have the same meaning as defined in § 40.1-5-2.

     (5) "Qualified healthcare services" means outpatient behavioral healthcare services,

including, but not limited to, services provided by mental health professionals.

     27-38.3-4. Powers and duties.

     In addition to the powers and duties promulgated in § 42-14.5-3, the health insurance

commissioner appointed pursuant to the provisions of § 42-14.5-1 shall have the following powers

and duties:

     (1) To investigate and establish minimum reimbursement rates to be paid to providers by

health insurers for qualified healthcare services pursuant to § 27-38.3-5;

     (2) To establish maximum timeframes for payments by domestic health insurers to

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providers for qualified healthcare services;

     (3) To limit or eliminate co-payments, deductibles, and prior authorization requirements

imposed by domestic health insurers for qualified healthcare services;

     (4) To mandate specific qualified healthcare services that domestic health insurers must

cover;

     (5) To take enforcement action against any person or entity subject to the provisions of this

chapter who fails to comply with regulatory requirements imposed by the commissioner pursuant

to this chapter;

     (6) To conduct public hearings pursuant to the provisions of chapter 35 of title 42

("administrative procedures") for the purposes of making decisions pursuant to this chapter; and

     (7) To promulgate rules and regulations to implement the provisions of this chapter.

     27-38.3-5. Reimbursement rate determination.

     (a) The commissioner shall determine a minimum reimbursement rate to be paid to

providers by health insurers for qualified healthcare services. The minimum reimbursement rate

shall also not be less than the mean rate paid for qualified healthcare services by health insurers

and private pay patients in Massachusetts and Connecticut or one hundred fifty percent (150%) of

the Medicare reimbursement rate for equivalent services.

     (b) The commissioner shall consult with the mental health advocate on the implementation

of the provisions of this chapter.

     (c) The commissioner shall annually review and adjust the reimbursement rates.

     27-38.3-6. Enforcement.

     (a) The commissioner is authorized to initiate a complaint against any person or entity

failing to comply with the provisions of all reimbursement rate determinations or the rules and

regulations promulgated pursuant to the provisions of this chapter. Contested cases shall be

conducted pursuant to the provisions of § 42-35-9.

     (b) The commissioner shall adopt rules and regulations concerning hearings for persons or

entities allegedly violating the reimbursement rate determinations or other provisions of this

chapter or the rules and regulations promulgated pursuant to the provisions of this chapter.

     (c) The commissioner shall have the power after the hearing to issue an order that the

respondent to a complaint cease and desist from any further violation of this chapter, and/or take

any affirmative action including, but not limited to, ordering payment or reimbursement to any

person or entity suffering monetary loss as a result of the violation.

     (d) For a willful or repeated violation, the commissioner may impose a civil penalty of up

to ten thousand dollars ($10,000) per violation.

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     (e) A final order of the commissioner shall constitute an "order" within the meaning of §

42-35-1; is enforceable as an order; is to be rendered in accordance with § 42-35-12; and is subject

to judicial review in accordance with § 42-35-15.

     27-38.3-7. Private and representative actions.

     (a) On January 1, 2026 and thereafter, any person aggrieved by the failure of any entity to

comply with the provisions of this chapter or the promulgated rules and regulations implementing

the provisions of this chapter may bring an action pursuant to the rules of civil procedure in the

superior court to enforce the provisions of this chapter and to recover any actual damages suffered

from the violation of this chapter or the implementing rules and regulations. The court shall award

damages equal to three (3) times the amount of the actual proven damages plus attorneys' fees and

costs, in addition to injunctive or other equitable relief.

     (b) On January 1, 2026, and thereafter the attorney general, a representative of the office

of mental health advocate or any health care provider may bring an action pursuant to the rules of

civil procedure in the superior court for injunctive or other relief to enforce the provisions of this

chapter or the rules and regulations promulgated to implement this chapter.

     (c) In an action pursuant to subsection (b) of this section, the commissioner may be named

as a party to the litigation and the commissioner may be subject to the equitable jurisdiction of the

superior court for purpose of rate review and regulatory implementation and enforcement. Upon

finding that the commissioner failed to take action necessary to implement or to enforce the

provisions of this chapter, the court shall enter such orders as are necessary to accomplish the

provisions of this chapter.

     27-38.3-8. Severability.

     If any provisions of this chapter or its application to any person or circumstance is held

invalid, the invalidity shall not effect other provisions or applications of this chapter which shall be

given effect without the invalid provisions or applications, and to this end the provisions of this

chapter are severable.

     SECTION 2. This act shall take upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE -- MENTAL HEALTH SERVICE PROVIDER

COMPENSATION ACT

***

     This act would expand the authority of the health insurance commissioner. The

commissioner would have the authority to set reasonable reimbursement rates for mental health

professionals and limit or eliminate prior authorization for receipt of mental health services and co-

pays or deductibles for mental health-related medication.

     This act would take effect upon passage.

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