2024 -- S 2726 SUBSTITUTE A | |
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LC004759/SUB A | |
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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 -- ACCIDENT AND SICKNESS INSURANCE POLICIES | |
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Introduced By: Senators Bissaillon, DiMario, Lauria, LaMountain, Pearson, Miller, and | |
Date Introduced: March 05, 2024 | |
Referred To: Senate Health & Human Services | |
It is enacted by the General Assembly as follows: | |
1 | SECTION 1. Section 27-18-54 of the General Laws in Chapter 27-18 entitled "Accident |
2 | and Sickness Insurance Policies" is hereby amended to read as follows: |
3 | 27-18-54. Health insurance rates. |
4 | No insurance company organized as a stock or mutual corporation which merges or |
5 | consolidates with, acquires ownership or control or possession of twenty percent (20%) or greater |
6 | of the operating assets of, or otherwise acquires control of a non-profit hospital service corporation |
7 | organized under chapter 19 of this title, a non-profit medical service corporation organized under |
8 | chapter 20 of this title or a health maintenance organization organized under chapter 41 of this title |
9 | may: (1) file with any state agency for review or approval any proposed rate to be used by the |
10 | company in the state, or (2) charge to any party in the state any rate or premium, which takes into |
11 | account or reflects in any manner the value of any contribution, distribution or allocation the |
12 | company expends or incurs in establishing or funding a charitable foundation organized to maintain |
13 | or account for the assets of a non-profit hospital service corporation, non-profit medical service |
14 | corporation or health maintenance organization, or (3) pay a rate that is less than the approved |
15 | Medicaid rate set by the executive office of health and human services. For any rate that is to be |
16 | charged to policy holders, regardless of whether the rate is subject to approval by a state agency |
17 | under this or another chapter, the company shall at least thirty (30) days before implementing the |
18 | rate submit under oath to the commissioner of insurance an accounting that documents the cost |
19 | structure on which the rate is based and demonstrates the company’s compliance with this section. |
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1 | SECTION 2. Section 27-19-30.1 of the General Laws in Chapter 27-19 entitled "Nonprofit |
2 | Hospital Service Corporations" is hereby amended to read as follows: |
3 | 27-19-30.1. Health insurance rates. |
4 | No insurance company organized as a stock or mutual corporation that merges or |
5 | consolidates with, acquires ownership or control or possession of twenty percent (20%) or greater |
6 | of the operating assets of, or otherwise acquires control of a nonprofit hospital service corporation |
7 | organized under this chapter, a nonprofit medical service corporation organized under chapter 20 |
8 | of this title, or a health maintenance organization organized under chapter 41 of this title, may: (1) |
9 | File with any state agency for review or approval any proposed rate to be used by the company in |
10 | the state, or (2) Charge to any party in the state any rate or premium that takes into account or |
11 | reflects in any manner the value of any contribution, distribution, or allocation the company |
12 | expends or incurs in establishing or funding a charitable foundation organized to maintain or |
13 | otherwise account for the assets of a nonprofit hospital service corporation, nonprofit medical |
14 | service corporation, or health maintenance organization, or (3) pay a rate that is less than the |
15 | approved Medicaid rate set by the executive office of health and human services. For any rate that |
16 | is to be charged to policyholders, regardless of whether the rate is subject to approval by a state |
17 | agency under this or another chapter, the company shall at least thirty (30) days before |
18 | implementing the rate submit under oath to the commissioner of insurance an accounting that |
19 | documents the cost structure on which the rate is based and demonstrates the company’s |
20 | compliance with this section. |
21 | SECTION 3. Section 27-20-25.2 of the General Laws in Chapter 27-20 entitled "Nonprofit |
22 | Medical Service Corporations" is hereby amended to read as follows: |
23 | 27-20-25.2. Health insurance rates. |
24 | No insurance company organized as a stock or mutual corporation that merges or |
25 | consolidates with; acquires ownership or control or possession of twenty percent (20%) or greater |
26 | of the operating assets of; or acquires control of a nonprofit hospital service corporation organized |
27 | under chapter 19 of this title, a nonprofit medical service corporation organized under this chapter, |
28 | or a health maintenance organization organized under chapter 41 of this title may: (1) File with any |
29 | state agency for review or approval any proposed rate to be used by the company in the state, or |
30 | (2) Charge to any party in the state any rate or premium, that takes into account or reflects in any |
31 | manner the value of any contribution, distribution, or allocation the company expends or incurs in |
32 | establishing or funding a charitable foundation organized to maintain or account for the assets of a |
33 | nonprofit hospital service corporation, nonprofit medical service corporation, or health |
34 | maintenance organization, or (3) pay a rate that is less than the approved Medicaid rate set by the |
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1 | executive office of health and human services. For any rate that is to be charged to policyholders, |
2 | regardless of whether this rate is subject to approval by a state agency under this or another chapter, |
3 | the company shall at least thirty (30) days before implementing the rate submit under oath to the |
4 | commissioner of insurance an accounting that documents the cost structure on which the rate is |
5 | based and demonstrates the company’s compliance with this section. |
6 | SECTION 4. Section 27-38.2-1 of the General Laws in Chapter 27-38.2 entitled "Insurance |
7 | Coverage for Mental Illness and Substance Use Disorders" is hereby amended to read as follows: |
8 | 27-38.2-1. Coverage for treatment of mental health and substance use disorders. |
9 | (a) A group health plan and an individual or group health insurance plan shall provide |
10 | coverage for the treatment of mental health and substance use disorders under the same terms and |
11 | conditions as that coverage is provided for other illnesses and diseases. |
12 | (b) Coverage for the treatment of mental health and substance use disorders shall not |
13 | impose any annual or lifetime dollar limitation. |
14 | (c) Financial requirements and quantitative treatment limitations on coverage for the |
15 | treatment of mental health and substance use disorders shall be no more restrictive than the |
16 | predominant financial requirements applied to substantially all coverage for medical conditions in |
17 | each treatment classification. |
18 | (d) Coverage shall not impose non-quantitative treatment limitations for the treatment of |
19 | mental health and substance use disorders unless the processes, strategies, evidentiary standards, |
20 | or other factors used in applying the non-quantitative treatment limitation, as written and in |
21 | operation, are comparable to, and are applied no more stringently than, the processes, strategies, |
22 | evidentiary standards, or other factors used in applying the limitation with respect to |
23 | medical/surgical benefits in the classification. |
24 | (e) The following classifications shall be used to apply the coverage requirements of this |
25 | chapter: (1) Inpatient, in-network; (2) Inpatient, out-of-network; (3) Outpatient, in-network; (4) |
26 | Outpatient, out-of-network; (5) Emergency care; and (6) Prescription drugs. |
27 | (f) Medication-assisted treatment or medication-assisted maintenance services of substance |
28 | use disorders, opioid overdoses, and chronic addiction, including methadone, buprenorphine, |
29 | naltrexone, or other clinically appropriate medications, is included within the appropriate |
30 | classification based on the site of the service. |
31 | (g) Payors shall rely upon the criteria of the American Society of Addiction Medicine when |
32 | developing coverage for levels of care for substance use disorder treatment. |
33 | (h) Patients with substance use disorders shall have access to evidence-based, non-opioid |
34 | treatment for pain, therefore coverage shall apply to medically necessary chiropractic care and |
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1 | osteopathic manipulative treatment performed by an individual licensed under § 5-37-2. |
2 | (i) Parity of cost-sharing requirements. Regardless of the professional license of the |
3 | provider of care, if that care is consistent with the provider’s scope of practice and the health plan’s |
4 | credentialing and contracting provisions, cost sharing for behavioral health counseling visits and |
5 | medication maintenance visits shall be consistent with the cost sharing applied to primary care |
6 | office visits. |
7 | (j) A group health plan and an individual or group health insurance plan shall reimburse |
8 | providers of mental health and substance use disorders licensed under § 40.1-1-13 at rates of |
9 | reimbursement equal to, or greater than, the Medicaid rate schedule as established by the executive |
10 | office of health and human services. |
11 | SECTION 5. Section 27-41-27.2 of the General Laws in Chapter 27-41 entitled "Health |
12 | Maintenance Organizations" is hereby amended to read as follows: |
13 | 27-41-27.2. Health insurance rates. |
14 | No insurance company organized as a stock or mutual corporation that merges or |
15 | consolidates with, acquires ownership or control or possession of twenty percent (20%) or greater |
16 | of the operating assets of, or acquires control of a nonprofit hospital service corporation organized |
17 | under chapter 19 of this title, a nonprofit medical service corporation organized under chapter 20 |
18 | of this title, or a health maintenance organization organized under chapter 41 of this title: (1) May |
19 | file with any state agency for review or approval any proposed rate to be used by the company in |
20 | the state, or (2) May charge to any party in the state any rate or premium, that takes into account or |
21 | reflects in any manner the value of any contribution, distribution, or allocation the company |
22 | expends or incurs in establishing or funding a charitable foundation organized to maintain or |
23 | account for the assets of a nonprofit hospital service corporation, nonprofit medical service |
24 | corporation, or health maintenance organization, or (3) pay a rate that is less than the approved |
25 | Medicaid rate set by the executive office of health and human services. For any rate that is to be |
26 | charged to policyholders, regardless of whether this rate is subject to approval by a state agency |
27 | under this or another chapter, the company shall at least thirty (30) days before implementing the |
28 | rate submit under oath to the commissioner of insurance an accounting that documents the cost |
29 | structure on which the rate is based and demonstrates the company’s compliance with this section. |
30 | SECTION 6. Chapter 40-8 of the General Laws entitled "Medical Assistance" is hereby |
31 | amended by adding thereto the following section: |
32 | 40-8-33. Payments for treatment of mental health and substance use disorders. |
33 | The executive office of health and human services, its subordinate agencies and |
34 | contractors, including managed care organizations, shall reimburse providers of mental health and |
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1 | substance use disorders licensed under § 40.1-1-13 at rates of reimbursement equal to, or greater |
2 | than, the Medicaid rate schedule as established by the executive office of health and human |
3 | services. |
4 | SECTION 7. This act shall take effect on January 1, 2025. |
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LC004759/SUB A | |
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EXPLANATION | |
BY THE LEGISLATIVE COUNCIL | |
OF | |
A N A C T | |
RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES | |
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1 | This act would prohibit insurance companies from paying a rate that is less than the |
2 | approved Medicaid rate set by the executive office of health and human services. |
3 | This act would take effect on January 1, 2025. |
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LC004759/SUB A | |
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