2016 -- S 2461 SUBSTITUTE A

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LC004711/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 INSURANCE - INSURANCE COVERAGE FOR MENTAL ILLNESS AND

SUBSTANCE ABUSE

     Introduced By: Senators Miller, Satchell, Nesselbush, Coyne, and Sheehan

     Date Introduced: February 11, 2016

     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) 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) Health practitioners prescribing as permitted under chapter 28.1 of title 21 (uniform

controlled substance act) and health plan coverage shall support clinical practices that foster the

appropriate use of abuse-deterrent opioid analgesic drug product formulations that are approved

by the U.S. Food and Drug Administration, in accordance with subsection (c) of this section, and

department of health regulations.

     (i) 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 assess abuse deterrent products. All health plans shall include at least one abuse-deterrent

formulation on the lower cost prescription drug co-payment tiers.

     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 require health care practitioners and health plan coverage to support

clinical practices fostering the appropriate use of abuse-deterrent opioid analgesic drug product

formulations approved by the U.S. Food and Drug Administration and department of health

regulations. It would require health plans to include at least one abuse-deterrent formulation on

the lower cost prescription drug co-payment tiers.

     This act would take effect upon passage.

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