2017 -- H 5218 SUBSTITUTE A

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LC000735/SUB A/2

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2017

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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, Jacquard, Ackerman, and Vella-
Wilkinson

     Date Introduced: January 26, 2017

     Referred To: House Corporations

     (Attorney General)

It is enacted by the General Assembly as follows:

     SECTION 1. Chapter 23-17.26 of the General Laws entitled "Comprehensive Discharge

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

     23-17.26-5. Comprehensive patient consent form.

     Each hospital and freestanding emergency-care facility shall incorporate patient consent

for peer recovery coach services into a comprehensive patient consent form to be implemented no

later than January 1, 2018.

     SECTION 2. 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, and any

contract between the Rhode Island Medicaid program and any health insurance carrier, as defined

under chapters 18, 19, 20, and 41 of title 27, 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 treatment or medication-assisted maintenance services of

substance-use disorders, opioid overdoses, and chronic addiction, including methadone,

buprenorphine, naltrexone, or other clinically appropriate medications, 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) Consistent with coverage for medical and surgical services, a health insurer shall

cover clinically appropriate residential or inpatient services, including detoxification and

stabilization services, for the treatment of mental health and/or substance-use disorders, including

alcohol-use disorders, in accordance with this subsection. After an appropriate psychiatric

assessment for mental health, or an assessment for substance-use disorders, including alcohol-use

disorders, based upon the criteria of the American Society of Addiction Medicine, conducted

upon an emergency admission or for continuation of care, if a qualified medical and/or clinical

professional determines that residential or inpatient care, including detoxification and

stabilization services, is the most appropriate and least restrictive level of care necessary, that

professional shall, within twenty-four (24) hours of admission or at least twenty-four (24) hours

prior to the expiration of any previous authorization from the health insurer, submit a treatment

plan, including an estimated length of stay and such other information as may be reasonably

requested by the health insurer, to the patient's health insurer. The health insurer shall review the

information submitted in accordance with the timelines and requirements of chapter 18.9 of title

27; provided, that the patient shall be and remain presumptively covered for residential or

inpatient services, including detoxification and stabilization services, during the authorization or

LC000735/SUB A/2 - Page 2 of 4

concurrent assessment review. On or before March 1, 2020, the senate committee on health and

human services, in conjunction with the house committee on corporations, shall conduct a hearing

on the impact of this subsection, to include presentations from payors and providers, and other

stakeholders at the discretion of the committee chairs. This subsection shall apply only to covered

services delivered within the health insurer's provider network.

     SECTION 3. This act shall take effect on November 1, 2017.

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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 provide that a payor may not deny continued residential or inpatient

treatment coverage due to medical necessity and appropriateness of treatment under Rhode Island

law if the subscriber has been admitted and is currently in residential or inpatient services for a

mental health and/or substance use disorder and the provider of treatment has recommended

continued residential or inpatient treatment, and would incorporate patient consent for peer

recovery services into the comprehensive patient consent form.

     This act would take effect on November 1, 2017.

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