2017 -- S 0329 SUBSTITUTE A

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LC001270/SUB A

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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:

     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 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, patients with mental

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

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

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

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

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

patient will remain presumptively eligible for residential or inpatient services during the payment

authorization period. The office of the health insurance commissioner shall promulgate

regulations that define reasonable payment authorization procedures and timelines for payors.

     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

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

services.

     This act would take effect upon passage.

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