2019 -- H 5120

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LC000560

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2019

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A N   A C T

RELATING TO INSURANCE - ACCIDENT AND SICKNESS INSURANCE POLICIES

     

     Introduced By: Representatives Morin, Phillips, Casey, Vella-Wilkinson, and Millea

     Date Introduced: January 11, 2019

     Referred To: House Health, Education & Welfare

     It is enacted by the General Assembly as follows:

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     SECTION 1. Chapter 27-18 of the General Laws entitled "Accident and Sickness

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Insurance Policies" is hereby amended by adding thereto the following section:

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     27-18-85. Coverage for physical therapy, occupational therapy, massage therapy,

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and the healing art of acupuncture and oriental medicine.

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     Every individual or group health insurance contract, plan, or policy contract delivered,

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issued for delivery, or renewed in this state on or after January 1, 2020, shall provide coverage for

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physical therapy performed by an individual licensed under chapter 40 of title 5, occupational

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therapy performed by an individual licensed under chapter 40 of title 5, massage therapy

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performed by an individual licensed under chapter 20.8 of title 23, and the healing art of

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acupuncture and oriental medicine performed by an individual licensed under chapter 37.2 of title

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5.

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     SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service

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

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     27-19-77. Coverage for physical therapy, occupational therapy, massage therapy,

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and the healing art of acupuncture and oriental medicine.

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     Every individual or group health insurance contract, plan, or policy contract delivered,

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issued for delivery, or renewed in this state on or after January 1, 2020, shall provide coverage for

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physical therapy performed by an individual licensed under chapter 40 of title 5, occupational

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therapy performed by an individual licensed under chapter 40.1 of title 5, massage therapy

 

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performed by an individual licensed under chapter 20.8 of title 23, and the healing art of

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acupuncture and oriental medicine performed by an individual licensed under chapter 37.2 of title

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5.

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     SECTION 3. 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 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) Patients with substance-use disorders shall have access to evidence-based, non-opioid

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treatment for pain, therefore and coverage shall apply to medically necessary chiropractic care

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and osteopathic manipulative treatment performed by an individual licensed under ยง 5-37-2

 

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physical therapy performed by an individual licensed under chapter 40 of title 5, occupational

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therapy performed by an individual licensed under chapter 40.1 of title 5, massage therapy

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performed by an individual licensed under chapter 20.8 of title 23, and the healing art of

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acupuncture and oriental medicine performed by an individual licensed under chapter 37.2 of title

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5.

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     (i) Parity of cost-sharing requirements. Regardless of the professional license of the

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provider of care, if that care is consistent with the provider's scope of practice and the health

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plan's credentialing and contracting provisions, cost-sharing for behavioral health counseling

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visits and medication maintenance visits shall be consistent with the cost-sharing applied to

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primary care office visits.

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     SECTION 4. This act shall take effect on January 1, 2020,

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE - ACCIDENT AND SICKNESS INSURANCE POLICIES

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     This act would require health insurance contract plans or policies to provide coverage for

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certain licensed practices including physical therapy, occupational therapy, massage therapy,

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acupuncture and oriental medicine and would consider such licensed practices as "evidence

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based, non-opioid treatments for pain."

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     This act would take effect on January 1, 2020.

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