2016 -- H 7948

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LC005317

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2016

____________

A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES--

EATING DISORDERS

     

     Introduced By: Representative Robert A. Nardolillo

     Date Introduced: March 16, 2016

     Referred To: House Corporations

     (by request)

It is enacted by the General Assembly as follows:

1

     SECTION 1. Chapter 27-18 of the General Laws entitled "Accident and Sickness

2

Insurance Policies" is hereby amended by adding thereto the following section:

3

     27-18-82. Eating Disorders. -- (a) Every individual or group health insurance contract,

4

plan, or policy that provides prescription coverage that is delivered, issued for delivery, amended

5

or renewed in this state on or after January 1, 2017, shall provide coverage for all eating disorders

6

and all necessary devices and services related thereto, including provision of patient information.

7

     (b) As used in this section:

8

     (1) "Eating disorder" means anorexia, bulimia, and any other condition considered by the

9

medical community as constituting an eating disorder.

10

     (c) The coverage mandated by this section shall include a broad array of specialist

11

services as prescribed as necessary by the patient's treatment team. Coverage under this section is

12

limited to medically necessary treatment and the treatment plan must include all elements

13

necessary for a health benefit plan to pay claims. Under this section medical necessity

14

determinations and care management for the treatment of eating disorders shall consider the

15

overall medical and mental health needs of the individual with the eating disorder and shall not be

16

based solely on weight. Coverage may be subject to other general exclusions and limitations of

17

the contract or benefit plan not in conflict with this section.

18

     (d) Notwithstanding §27-18-19 or any other provision to the contrary, this section shall

 

1

apply to blanket or group polices of insurance.

2

     SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service

3

Corporations" is hereby amended by adding thereto the following section:

4

     27-19-73. Eating disorders. -- (a) Every individual or group health insurance contract,

5

plan, or policy that provides prescription coverage that is delivered, issued for delivery, amended

6

or renewed in this state on or after January 1, 2017, shall provide coverage for all eating disorders

7

and all necessary devices and services related thereto, including provision of patient information.

8

     (b) As used in this section:

9

     (1) "Eating disorder" means anorexia, bulimia, and any other condition considered by the

10

medical community as constituting an eating disorder.

11

     (c) The coverage mandated by this section shall include a broad array of specialist

12

services as prescribed as necessary by the patient's treatment team. Coverage under this section is

13

limited to medically necessary treatment and the treatment plan must include all elements

14

necessary for a health benefit plan to pay claims. Under this section medical necessity

15

determinations and care management for the treatment of eating disorders shall consider the

16

overall medical and mental health needs of the individual with the eating disorder and shall not be

17

based solely on weight. Coverage may be subject to other general exclusions and limitations of

18

the contract or benefit plan not in conflict with this section.

19

     (d) Notwithstanding §27-18-19 or any other provision to the contrary, this section shall

20

apply to blanket or group polices of insurance.

21

     SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service

22

Corporations" is hereby amended by adding thereto the following section:

23

     27-20-69. Eating disorders. -- (a) Every individual or group health insurance contract,

24

plan, or policy that provides prescription coverage that is delivered, issued for delivery, amended

25

or renewed in this state on or after January 1, 2017, shall provide coverage for all eating disorders

26

and all necessary devices and services related thereto, including provision of patient information.

27

     (b) As used in this section:

28

     (1) "Eating disorder" means anorexia, bulimia, and any other condition considered by the

29

medical community as constituting an eating disorder.

30

     (c) The coverage mandated by this section shall include a broad array of specialist

31

services as prescribed as necessary by the patient's treatment team. Coverage under this section is

32

limited to medically necessary treatment and the treatment plan must include all elements

33

necessary for a health benefit plan to pay claims. Under this section medical necessity

34

determinations and care management for the treatment of eating disorders shall consider the

 

LC005317 - Page 2 of 4

1

overall medical and mental health needs of the individual with the eating disorder and shall not be

2

based solely on weight. Coverage may be subject to other general exclusions and limitations of

3

the contract or benefit plan not in conflict with this section.

4

     (d) Notwithstanding §27-18-19 or any other provision to the contrary, this section shall

5

apply to blanket or group polices of insurance.

6

     SECTION 4. Chapter 27-41 of the General Laws entitled "Health Maintenance

7

Organizations" is hereby amended by adding thereto the following section:

8

     27-41-86. Eating disorders. -- (a) Every individual or group health insurance contract,

9

plan, or policy that provides prescription coverage that is delivered, issued for delivery, amended

10

or renewed in this state on or after January 1, 2017, shall provide coverage for all eating disorders

11

and all necessary devices and services related thereto, including provision of patient information.

12

     (b) As used in this section:

13

     (1) "Eating disorder" means anorexia, bulimia, and any other condition considered by the

14

medical community as constituting an eating disorder.

15

     (c) The coverage mandated by this section shall include a broad array of specialist

16

services as prescribed as necessary by the patient's treatment team. Coverage under this section is

17

limited to medically necessary treatment and the treatment plan must include all elements

18

necessary for a health benefit plan to pay claims. Under this section medical necessity

19

determinations and care management for the treatment of eating disorders shall consider the

20

overall medical and mental health needs of the individual with the eating disorder and shall not be

21

based solely on weight. Coverage may be subject to other general exclusions and limitations of

22

the contract or benefit plan not in conflict with this section.

23

     (d) Notwithstanding §27-18-19 or any other provision to the contrary, this section shall

24

apply to blanket or group polices of insurance.

25

     SECTION 5. This act shall take effect on January 1, 2017.

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LC005317 - Page 3 of 4

EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES--

EATING DISORDERS

***

1

     This act would require health insurance providers to provide coverage for eating

2

disorders. This would apply to nonprofit hospital service corporations, nonprofit medical service

3

corporations and health maintenance organizations.

4

     This act would take effect on January 1, 2017.

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LC005317

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LC005317 - Page 4 of 4