It is enacted by the General Assembly as follows:

SECTION 1. Section 27-38-1 of the General Laws in Chapter 27-38 entitled "Insurance Coverage for Treatment of Substance Abuse" is hereby amended to read as follows:

{ADD 27-38-1. Health insurance coverage. -- ADD} (a) Every health insurer shall provide coverage for services relating to medically necessary treatment for substance dependency and substance abuse {ADD , including medically necessary treatment for substance dependency and substance abuse which is ordered as a condition of sentencing by any court in the State of Rhode Island. The court ordered treatment must be within the provisions of this chapter. ADD} For purposes of this chapter, the term "substance dependency and substance abuse" is defined as the pattern of pathological use of alcohol or other psychoactive drugs characterized by impairments in social and/or occupational functioning, debilitating physical condition, inability to abstain from or reduce consumption of the substance, or the need for daily substance use for adequate functioning. The term "substance" is defined to include alcohol and those drugs included on the {DEL department of mental health, retardation, and hospitals (MHRH) division of substance abuse DEL} {ADD department of substance abuse ADD} list of addictive drugs as of January 1, 1988; provided, however, that tobacco and caffeine are hereby excluded from the definition of "substance" for purposes of this chapter.

(b) Benefits for expenses arising from medically necessary treatment for substance dependency and substance abuse shall include the following and shall be reimbursed in accordance with the provisions of this chapter and the reimbursement policies and procedures of each health insurer:

(1) Benefits based upon inpatient services in a hospital licensed in Rhode Island or in a {DEL J.C.A.H. (joint commission on accreditation of hospitals) accredited DEL} {DEL and MHRH (department of mental health, retardation, and hospitals) DEL} {ADD department of substance abuse (DSA) ADD} licensed community residential facility for substance dependency and substance abuse treatment as defined in chapter 24-40.1 of the general laws shall be reimbursed in accordance with each health insurer's respective principles and mechanisms of reimbursement for services provided by hospitals, skilled nursing facilities, or other nonhospital providers of substance dependency and substance abuse services;

(2) Benefits based upon day or evening treatment services and/or partial hospitalization services in a hospital licensed in Rhode Island or in a {DEL J.C.A.H. accredited and MHRH DEL} {ADD (DSA) ADD} licensed community residential facility for substance dependency and substance abuse treatment as defined in chapter 24-40.1 of the general laws or a {DEL MHRH DEL} {ADD (DSA) ADD} licensed nonresidential facility for substance abuse treatment as defined in chapter 24-40.1 of the general laws shall be reimbursed in accordance with each health insurer's respective principles and mechanisms of reimbursement for services provided by hospitals, skilled nursing facilities, or other nonhospital providers of substance dependency and substance abuse services; and

(3) Outpatient benefits of thirty (30) hours for each individual under treatment and twenty (20) hours for family members in any twelve (12) month period shall cover substance dependency and substance abuse services furnished in a hospital licensed in Rhode Island or in a {DEL MHRH DEL} {ADD (DSA) ADD} licensed public or private facility providing services especially for the rehabilitation of substance abusers.

(c) Benefits under subsections (b)(1) and (b)(2) shall be provided as follows:

(1) Detoxification benefits shall be provided for up to three (3) detoxification occurrences or twenty-one (21) days per year, whichever comes first; and

(2) Intensive rehabilitation services benefits shall be provided for a period not to exceed thirty (30) days in any twelve (12) month period. Health insurers shall provide a lifetime benefit per patient of ninety (90) days for intensive rehabilitation. In calculating those benefits:

(i) One day of treatment provided in a residential treatment program shall be counted as one day of intensive rehabilitation treatment; and

(ii) Two days of treatment provided in a day or evening and/or partial hospitalization program shall be counted as one day of intensive rehabilitative treatment.

(d) There shall be no reimbursement under subsection (b) other than for facility payment.

(e) Licensed providers of substance dependency and substance abuse treatment shall submit to health insurers upon request financial data including financial statements, budgets, cost allocations, volume projections, charges and such other data necessary to determine reasonableness of costs and/or of charges.

(f) Health insurers shall not be required under this chapter to provide benefit coverage for substance dependency and substance abuse treatment services rendered at a facility located outside of Rhode Island unless that facility meets reasonable criteria established by the health insurers.

(g) Notwithstanding the terms and limitations set forth in subsections (b) and (f) , health insurers shall be required to provide benefit coverage for services at an out of state facility in cases where it can be established through a preadmission certification process that the treatment services required are not offered at any facility in Rhode Island or at any out of state facility that has met a health insurer's criteria.

{ADD (h) Nothing in this chapter shall prevent the conducting of managed care reviews and medical necessity reviews by an insurer or hospital, medical service corporation or health maintenance organization. ADD}

SECTION 2. This act shall take effect upon passage.