2017 -- S 0329

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LC001270

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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: Senators Miller, Goldin, Satchell, Sosnowski, and Goodwin

     Date Introduced: February 16, 2017

     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

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coverage 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 treatment or medication-assisted maintenance services of

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

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buprenorphine, naltrexone, or other clinically appropriate medications, is included within the

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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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     (h) Consistent with coverage for medical and surgical services, patients with mental

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health and/or substance-use disorders are presumptively eligible for emergency admission

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practices, including any appropriate inpatient services. After an appropriate psychiatric

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assessment, if a qualified medical professional determines that continued residential or inpatient

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care is necessary care for a patient, that professional will submit a treatment plan, including an

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estimated length of stay, to the patient's payor for authorization of payment. A patient will remain

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presumptively eligible for residential or inpatient services during the payment authorization

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period. The office of the health insurance commissioner shall promulgate regulations that define

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reasonable payment authorization procedures and timelines for payors.

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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 provide that patients with mental health and/or substance-use disorders

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are presumptively eligible for emergency admission practices, including any appropriate inpatient

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services.

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     This act would take effect upon passage.

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