2016 -- S 2356 SUBSTITUTE A

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LC004564/SUB A/2

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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 HEALTH AND SAFETY -- INSURANCE--MENTAL ILLNESS AND

SUBSTANCE ABUSE - THE ALEXANDER C. PERRY ACT

     

     Introduced By: Senators Miller, Jabour, Crowley, Goodwin, and Satchell

     Date Introduced: February 10, 2016

     Referred To: Senate Health & Human Services

     It is enacted by the General Assembly as follows:

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     SECTION 1. Section 23-17.26-3 of the General Laws in Chapter 23-17.26 entitled

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"Comprehensive Discharge Planning" is hereby amended to read as follows:

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     23-17.26-3. Comprehensive discharge planning. -- (a) On or before July 1, 2015

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September 1, 2016, each hospital and freestanding emergency care facility operating in the State

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of Rhode Island shall submit to the director:

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     (1) With patient consent, each patient presenting to a hospital or freestanding emergency

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care facility with indication of a substance use disorder, opioid overdose, or chronic addiction

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shall receive a substance abuse evaluation, in accordance with the standards in subsection

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(a)(5)(ii) of this section, before discharge. Prior to the dissemination of the standards in

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subsection (a)(5)(ii) of this section, with patient consent, each patient presenting to a hospital or

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freestanding emergency care facility with indication of a substance use disorder, opioid overdose,

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or chronic addiction shall receive a substance abuse evaluation, in accordance with best practices

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standards, before discharge.

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     (1)(2) Evidence of participation in a high-quality comprehensive discharge planning and

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transitions improvement project operated by a nonprofit organization in this state; or

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     (2)(3) A plan for the provision of comprehensive discharge planning and information to

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be shared with patients transitioning from the hospitals hospital's or freestanding emergency care

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facility's care. Such plan shall contain the adoption of evidence-based practices including, but not

 

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limited to:

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     (i) Providing in-hospital education in the hospital or freestanding emergency care facility

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prior to discharge;

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     (ii) Ensuring patient involvement such that, at discharge, patients and caregivers

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understand the patient's conditions and medications and have a point of contact for follow-up

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questions;

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     (iii) With patient consent, attempting to notify the person(s) listed as the patient's

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emergency contacts and recovery coach before discharge. If the patient refuses to consent to the

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notification of emergency contacts, such refusal shall be noted in the patient's medical record;

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     (iii)(iv) Attempting to identify patients' primary care providers and assisting with

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scheduling post-hospital post-discharge follow-up appointments prior to patient discharge;

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     (iv)(v) Expanding the transmission of the department of health's continuity of care form,

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or successor program, to include primary care providers' receipt of information at patient

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discharge when the primary care provider is identified by the patient; and

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     (v)(vi) Coordinating and improving communication with outpatient providers.

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     (3)(4) The discharge plan and transition process shall also be made include recovery

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planning tools for patients with opioid and other substance use disorders substance use disorders,

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opioid overdoses, and chronic addiction, which plan and transition process shall include the

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elements contained in subsections (a)(1) (a)(2) or (a)(2) (a)(3) of this section, as applicable. In

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addition, such discharge plan and transition process shall also include:

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     (i) Assistance, with patient consent, in securing at least one follow-up appointment for

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the patient within seven (7) days of discharge, as clinically appropriate: (A) With a facility

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licensed by the department of behavioral healthcare, developmental disabilities and hospitals to

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provide treatment of substance use disorders; (B) With a certified recovery coach; (C) With a

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licensed clinician with expertise in the treatment of substance use disorders; or (D) With a Rhode

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Island licensed hospital with a designated program for the treatment of substance use disorders.

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The patient shall be informed of said appointment prior to the patient being discharged from the

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hospital;

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     (ii) In the absence of a scheduled follow-up appointment pursuant to subsection (a)(3)(i),

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every reasonable effort shall be made to contact the patient within thirty (30) days post-discharge

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to provide the patient with a referral and other such assistance as the patient needs to obtain a

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follow-up appointment; and

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     (iii) That the patient receives information about the real-time availability of appropriate

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in-patient and out-patient services in Rhode Island.

 

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     (i) That if, after the completion of a substance abuse evaluation, in accordance with the

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standards in subsection (a)(5)(ii) of this section, the clinically appropriate inpatient and outpatient

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services for the treatment of substance use disorders, opioid overdose, or chronic addiction

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contained in subsection (a)(4)(iii) of this section are not immediately available, the hospital or

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freestanding emergency care facility shall provide medically necessary and appropriate services

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until the appropriate transfer of care is completed;

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     (ii) That with patient consent, pursuant to 21 C.F.R. ยง1306.07, a physician in a hospital or

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freestanding emergency care facility who is not specifically registered to conduct a narcotic

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treatment program may administer narcotic drugs, including buprenorphine, to a person for the

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purpose of relieving acute opioid withdrawal symptoms when necessary while arrangements are

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being made for referral for treatment. No more than one day's medication may be administered to

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the person or for the person's use at one time. Such emergency treatment may be carried out for

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not more than three (3) days and may not be renewed or extended;

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     (iii) That each patient presenting to a hospital or freestanding emergency care facility

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with indication of a substance use disorder, opioid overdose, or chronic addiction shall receive

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information, made available to the hospital or freestanding emergency care facility in accordance

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with subsection (a)(5)(v) of this section, about the availability of clinically appropriate inpatient

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and outpatient services for the treatment of substance use disorders, opioid overdose, or chronic

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addiction, including:

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     (A) Detoxification;

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     (B) Stabilization;

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     (C) Medication-assisted treatment or medication-assisted maintenance services, including

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methadone, buprenorphine, naltrexone or other clinically appropriate medications;

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     (D) Inpatient and residential treatment;

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     (E) Licensed clinicians with expertise in the treatment of substance use disorders, opioid

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overdoses, and chronic addiction;

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     (F) Certified recovery coaches; and

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     (iv) That when the real-time patient services database outlined in subsection (a)(5)(vi) of

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this section becomes available, each patient shall receive real-time information from the hospital

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or freestanding emergency care facility about the availability of clinically appropriate inpatient

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and outpatient services.

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     (4)(5) On or before November 1, 2014 January 1, 2017, the director of the department of

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health, shall develop and disseminate to all hospitals, health care clinics, urgent care centers, and

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emergency room diversion facilities a model discharge plan and transition process for patients

 

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with opioid and other substance use disorders. This model plan may be used as a guide, but may

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be amended and modified to meet the specific needs of each hospital, health care clinic, urgent

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care center and emergency room diversion facility. with the director of the department of

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behavioral healthcare, developmental disabilities and hospitals, shall:

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     (i) Develop and disseminate to all hospitals and freestanding emergency care facilities a

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regulatory standard for the early introduction of a recovery coach during the pre-admission and/or

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admission process for patients with substance use disorders, opioid overdose, or chronic

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addiction;

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     (ii) Develop and disseminate to all hospitals and freestanding emergency care facilities

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substance abuse evaluation standards for patients with substance use disorders, opioid overdose,

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or chronic addiction;

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     (iii) Develop and disseminate to all hospitals and freestanding emergency care facilities

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pre-admission, admission, and discharge regulatory standards, a recovery plan and voluntary

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transition process for patients with substance use disorders, opioid overdose, or chronic addiction.

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Recommendations from the 2015 Rhode Island Governor's overdose prevention and intervention

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task force strategic plan may be incorporated into the standards as a guide, but may be amended

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and modified to meet the specific needs of each hospital and freestanding emergency care facility;

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     (iv) Develop and disseminate best practices standards for health care clinics, urgent care

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centers, and emergency diversion facilities regarding protocols for screening, transfer and referral

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to clinically appropriate inpatient and outpatient services contained in subsection (a)(4)(iii) of this

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section;

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     (v) Submit regulations for patients presenting to hospitals and freestanding emergency

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care facilities with indication of a substance use disorder, opioid overdose, or chronic addiction to

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ensure prompt, voluntary access to clinically appropriate inpatient and outpatient services

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contained in subsection (a)(4)(iii) of this section;

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     (vi) Submit a strategy to assess, develop, implement and maintain a database of real-time

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availability of clinically appropriate inpatient and outpatient services contained in subsection

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(a)(4)(iii) of this section on or before January 1, 2018.

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     SECTION 2. Section 27-38.2-1 of the General Laws in Chapter 27-38.2 entitled

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

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follows:

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

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

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

 

LC004564/SUB A/2 - Page 4 of 5

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

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

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impose any annual or lifetime dollar limitation.

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

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

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

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each treatment classification.

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

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

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

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

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

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medical/surgical benefits in the classification.

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

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

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

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     (f) Medication-assisted therapy including methadone, treatment or medication-assisted

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maintenance services of substance use disorders, opioid overdoses, and chronic addiction,

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including methadone, buprenorphine, naltrexone, or other clinically appropriate medications,

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maintenance services, for the treatment of substance-use disorders, opioid overdoses, and chronic

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addiction is included within the appropriate classification based on the site of the service.

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

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

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     SECTION 3. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO HEALTH AND SAFETY -- INSURANCE--MENTAL ILLNESS AND

SUBSTANCE ABUSE - THE ALEXANDER C. PERRY ACT

***

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     This act would require comprehensive discharge planning for patients treated for

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substance use disorders, opioid overdoses, and chronic addiction and would require insurers to

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cover medication-assisted addiction treatment including methadone, buprenorphine, and

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naltrexone.

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     This act would take effect upon passage.

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