2016 -- H 7625 SUBSTITUTE A

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LC004482/SUB A

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2016

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A N   A C T

RELATING TO INSURANCE -- INSURANCE COVERAGE FOR MENTAL ILLNESS AND

SUBSTANCE ABUSE

     Introduced By: Representatives Serpa, Fellela, Almeida, Williams, and McKiernan

     Date Introduced: February 12, 2016

     Referred To: House Corporations

     (Attorney General)

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.

     (h) A payor may not deny continued residential or inpatient treatment coverage due to

medical necessity and appropriateness of treatment under §27-38.2-3 if the subscriber has been

admitted and is currently in residential or inpatient services for a mental health and/or substance

abuse disorder and the provider of treatment has recommended continued residential or inpatient

treatment based upon the criteria of the American Society of Addiction Medicine.

     SECTION 2. 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 -- INSURANCE COVERAGE FOR MENTAL ILLNESS AND

SUBSTANCE ABUSE

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     This act would prohibit insurers for mental illness and/or substance abuse from denying

continued coverage for residential or inpatient services if such services are medically necessary

and if the insured is admitted and currently in residential or inpatient treatment or if the continued

treatment is recommended based on the criteria of the American Society of Addiction Medicine.

     This act would take effect upon passage.

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