2025 -- S 0271 SUBSTITUTE A | |
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LC001161/SUB A | |
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STATE OF RHODE ISLAND | |
IN GENERAL ASSEMBLY | |
JANUARY SESSION, A.D. 2025 | |
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A N A C T | |
RELATING TO INSURANCE -- BENEFIT DETERMINATION AND UTILIZATION | |
REVIEW ACT | |
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Introduced By: Senators Urso, DiMario, Lauria, Tikoian, Quezada, Rogers, Appollonio, | |
Date Introduced: February 13, 2025 | |
Referred To: Senate Health & Human Services | |
It is enacted by the General Assembly as follows: | |
1 | SECTION 1. Chapter 27-18.9 of the General Laws entitled "Benefit Determination and |
2 | Utilization Review Act" is hereby amended by adding thereto the following section: |
3 | 27-18.9-16. Utilization review decisions for the treatment of alcohol or substance use |
4 | disorder. |
5 | (a) For health benefit plans issued or renewed on or after the effective date of this section, |
6 | an insurer shall not require or conduct a prospective or concurrent review for a prescription |
7 | medicine: |
8 | (1) That is used in the treatment of alcohol or opioid use disorder and contains Methadone, |
9 | Buprenorphine or Naltrexone; or |
10 | (2) That is used in the treatment of alcohol or opioid use disorder and was approved before |
11 | the effective date of this section by the United States Food and Drug Administration for the |
12 | mitigation of opioid withdrawal symptoms. |
13 | SECTION 2. Chapter 40-8 of the General Laws entitled "Medical Assistance" is hereby |
14 | amended by adding thereto the following section: |
15 | 40-8-33. Utilization reviews for Medicaid benefits. |
16 | In conducting utilization reviews for Medicaid benefits, each Medicaid managed care |
17 | organization shall use the medical necessity criteria selected by the executive office of health and |
18 | human services for making determinations of medical necessity and clinical appropriateness |
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1 | pursuant to the utilization review plan. |
2 | SECTION 3. 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 -- BENEFIT DETERMINATION AND UTILIZATION | |
REVIEW ACT | |
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1 | This act would prohibit healthcare insurers from requiring or conducting a review for |
2 | prescription medicine that is used in the treatment of alcohol or opioid use disorder, that contains |
3 | Methadone, Burenorphine, or Naltrexone or that was approved for the mitigation of opioid |
4 | withdrawal symptoms. |
5 | This act would take effect upon passage. |
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