2018 -- S 2545 | |
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LC004868 | |
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STATE OF RHODE ISLAND | |
IN GENERAL ASSEMBLY | |
JANUARY SESSION, A.D. 2018 | |
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A N A C T | |
RELATING TO HEALTH AND SAFETY -- INSURANCE COVERAGE FOR MENTAL | |
ILLNESS AND SUBSTANCE ABUSE | |
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Introduced By: Senators Miller, Goldin, Calkin, Satchell, and Paolino | |
Date Introduced: March 01, 2018 | |
Referred To: Senate Health & Human Services | |
It is enacted by the General Assembly as follows: | |
1 | SECTION 1. Chapter 23-17.26 of the General Laws entitled "Comprehensive Discharge |
2 | Planning" is hereby amended by adding thereto the following section: |
3 | 23-17.26-5. comprehensive patient consent form. |
4 | Each hospital and freestanding emergency-care facility shall incorporate patient consent |
5 | for peer recovery coach services into a comprehensive patient consent form to be implemented no |
6 | later than January 1, 2019. |
7 | SECTION 2. Section 27-38.2-1 of the General Laws in Chapter 27-38.2 entitled |
8 | "Insurance Coverage for Mental Illness and Substance Abuse" is hereby amended to read as |
9 | follows: |
10 | 27-38.2-1. Coverage for treatment of mental health and substance use disorders. |
11 | [Effective April 1, 2018.]. |
12 | (a) A group health plan and an individual or group health insurance plan, and any |
13 | contract between the Rhode Island Medicaid program and any health insurance carrier, as defined |
14 | under chapters 18, 19, 20, and 41 of title 27, shall provide coverage for the treatment of mental |
15 | health and substance-use disorders under the same terms and conditions as that coverage is |
16 | provided for other illnesses and diseases. |
17 | (b) Coverage for the treatment of mental health and substance-use disorders shall not |
18 | impose any annual or lifetime dollar limitation. |
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1 | (c) Financial requirements and quantitative treatment limitations on coverage for the |
2 | treatment of mental health and substance-use disorders shall be no more restrictive than the |
3 | predominant financial requirements applied to substantially all coverage for medical conditions in |
4 | each treatment classification. |
5 | (d) Coverage shall not impose non-quantitative treatment limitations for the treatment of |
6 | mental health and substance-use disorders unless the processes, strategies, evidentiary standards, |
7 | or other factors used in applying the non-quantitative treatment limitation, as written and in |
8 | operation, are comparable to, and are applied no more stringently than, the processes, strategies, |
9 | evidentiary standards, or other factors used in applying the limitation with respect to |
10 | medical/surgical benefits in the classification. |
11 | (e) The following classifications shall be used to apply the coverage requirements of this |
12 | chapter: (1) Inpatient, in-network; (2) Inpatient, out-of-network; (3) Outpatient, in-network; (4) |
13 | Outpatient, out-of-network; (5) Emergency care; and (6) Prescription drugs. |
14 | (f) Medication-assisted treatment or medication-assisted maintenance services of |
15 | substance-use disorders, opioid overdoses, and chronic addiction, including methadone, |
16 | buprenorphine, naltrexone, or other clinically appropriate medications, is included within the |
17 | appropriate classification based on the site of the service. |
18 | (g) Payors shall rely upon the criteria of the American Society of Addiction Medicine |
19 | when developing coverage for levels of care for substance-use disorder treatment. |
20 | (h) Patients with substance-use disorders shall have access to evidence-based, non-opioid |
21 | treatment for pain, therefore coverage shall apply to medically necessary chiropractic care and |
22 | osteopathic manipulative treatment performed by an individual licensed under ยง 5-37-2. |
23 | (i) Consistent with coverage for medical and surgical services, a health insurer shall cover |
24 | clinically appropriate residential or inpatient services, including detoxification and stabilization |
25 | services, for the treatment of mental health and/or substance-use disorders, including alcohol-use |
26 | disorders, in accordance with this subsection. After an appropriate psychiatric assessment for |
27 | mental health, or an assessment for substance-use disorders, including alcohol-use disorders, |
28 | based upon the criteria of the American Society of Addiction Medicine, conducted upon an |
29 | emergency admission or for continuation of care, if a qualified medical and/or clinical |
30 | professional determines that residential or inpatient care, including detoxification and |
31 | stabilization services, is the most appropriate and least restrictive level of care necessary, that |
32 | professional shall, within twenty-four (24) hours of admission or at least twenty-four (24) hours |
33 | prior to the expiration of any previous authorization from the health insurer, submit a treatment |
34 | plan, including an estimated length of stay and such other information as may be reasonably |
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1 | requested by the health insurer, to the patient's health insurer. The health insurer shall review the |
2 | information submitted in accordance with the timelines and requirements of chapter 18.9 of title |
3 | 27, provided that the patient shall be and remain presumptively covered for residential or |
4 | inpatient services, including detoxification and stabilization services, during the authorization or |
5 | concurrent assessment review. On or before March 1, 2021, the senate committee on health and |
6 | human services, in conjunction with the house committee on corporations, shall conduct a hearing |
7 | on the impact of this subsection, to include presentations from payors and providers, and other |
8 | stakeholders at the discretion of the committee chairs. This subsection shall apply only to covered |
9 | services delivered within the health insurer's provider network. |
10 | SECTION 3. This act shall take effect upon passage. |
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EXPLANATION | |
BY THE LEGISLATIVE COUNCIL | |
OF | |
A N A C T | |
RELATING TO HEALTH AND SAFETY -- INSURANCE COVERAGE FOR MENTAL | |
ILLNESS AND SUBSTANCE ABUSE | |
*** | |
1 | This act would require insurance coverage for the treatment of mental health and |
2 | substance use disorders. |
3 | This act would take effect upon passage. |
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