2015 -- S 0167 SUBSTITUTE A

========

LC000379/SUB A/4

========

     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2015

____________

A N   A C T

RELATING TO INSURANCE - ACCESS TO ABUSE-DETERRENT PAIN MEDICATIONS

     Introduced By: Senators Miller, Crowley, Sosnowski, Goldin, and Jabour

     Date Introduced: February 05, 2015

     Referred To: Senate Health & Human Services

     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) Health practitioners prescribing as permitted under § 21-28-1.02(37) and health plan

coverage shall support clinical practices that foster the appropriate use of abuse-deterrent opioid

analgesic drug product formulations that are so approved by the U.S. Food and Drug

Administration, in accordance with subsection (c). When clinically appropriate, coverage for said

abuse-deterrent formulations will not require the use of a non-deterrent opioid analgesic drug

product formulation in order for patients to access abuse-deterrent products.

     SECTION 2. This act shall take effect upon passage.

========

LC000379/SUB A/4

========

LC000379/SUB A/4 - Page 2 of 2

EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE - ACCESS TO ABUSE-DETERRENT PAIN MEDICATIONS

***

     This act would require health practitioners and health plan coverage to support clinical

practices that foster the appropriate use of abuse-deterrent opioid analgesic drug product

formulations.

     This act would take effect upon passage.

========

LC000379/SUB A/4

========

LC000379/SUB A/4 - Page 3 of 2