2015 -- H 5837 SUBSTITUTE A

========

LC002069/SUB A

========

     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2015

____________

A N   A C T

RELATING TO INSURANCE - INSURANCE COVERAGE FOR MENTAL ILLNESS AND

SUBSTANCE ABUSE

     Introduced By: Representatives Serpa, Palangio, Fellela, Melo, and McNamara

     Date Introduced: March 11, 2015

     Referred To: House Corporations

     It is enacted by the General Assembly as follows:

     SECTION 1. Section 27-38.2-1 of the General Laws in Chapter 27-38.2 entitled

"Insurance Coverage for Mental Illness and Substance Abuse" is hereby amended to read as

follows:

     27-38.2-1. Coverage for the treatment of mental health and substance use disorders.

-- (a) A group health plan, and an individual or group health insurance plan shall provide

coverage for the treatment of mental health and substance use disorders under the same terms and

conditions as that coverage is provided for other illnesses and diseases.

      (b) Coverage for the treatment of mental health and substance use disorders shall not

impose any annual or lifetime dollar limitation.

      (c) Financial requirements and quantitative treatment limitations on coverage for the

treatment of mental health and substance use disorders shall be no more restrictive than the

predominant financial requirements applied to substantially all coverage for medical conditions in

each treatment classification.

      (d) Coverage shall not impose non-quantitative treatment limitations for the treatment of

mental health and substance use disorders unless the processes, strategies, evidentiary standards,

or other factors used in applying the non-quantitative treatment limitation, as written and in

operation, are comparable to, and are applied no more stringently than, the processes, strategies,

evidentiary standards, or other factors used in applying the limitation with respect to

medical/surgical benefits in the classification.

      (e) The following classifications shall be used to apply the coverage requirements of this

chapter: (1) Inpatient, in-network; (2) Inpatient, out-of-network; (3) Outpatient, in-network; (4)

Outpatient, out-of-network; (5) Emergency care; and (6) Prescription drugs.

      (f) Medication-assisted therapy, including methadone maintenance services, for the

treatment of substance use disorders, opioid overdoses, and chronic addiction is included within

the appropriate classification based on the site of the service.

     (g) Payors shall rely upon the criteria of the American Society of Addiction Medicine

when developing coverage for levels of care for substance use disorder treatment.

     SECTION 2. This act shall take effect upon passage.

========

LC002069/SUB A

========

LC002069/SUB A - Page 2 of 3

EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE - INSURANCE COVERAGE FOR MENTAL ILLNESS AND

SUBSTANCE ABUSE

***

     This act would require payors providing insurance coverage for the treatment of mental

health and substance abuse disorders to rely upon criteria of the American Society of Addiction

Medicine when developing coverage for levels of care for substance use disorder treatment.

     This act would take effect upon passage.

========

LC002069/SUB A

========

LC002069/SUB A - Page 3 of 3