2016 -- S 2461

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LC004711

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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:

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     SECTION 1. 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

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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 maintenance services, for the

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treatment of substance-use disorders, opioid overdoses, and chronic addiction is included within

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

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

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

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

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When clinically appropriate, coverage for said abuse-deterrent formulations will not require the

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use of a non-deterrent opioid analgesic drug product formulation in order for patients to access

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abuse-deterrent products. All health plans shall include one or more abuse deterrent formulations

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on the lower and lowest cost prescription drug co-payment tiers.

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     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 practitioners and health plan coverage to support clinical

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

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formulations approved by the U.S. Food and Drug Administration.

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     This act would take effect upon passage.

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