2019 -- S 0307 SUBSTITUTE A

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LC001231/SUB A/2

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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 HEALTH AND SAFETY - COMPREHENSIVE DISCHARGE PLANNING

     

     Introduced By: Senators Miller, Goldin, Satchell, Sheehan, and Valverde

     Date Introduced: February 13, 2019

     Referred To: Senate Health & Human Services

     It is enacted by the General Assembly as follows:

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

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

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     23-17.26-5. Comprehensive patient consent form.

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

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for certified peer recovery specialist services into a comprehensive patient consent form to be

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implemented no later than January 1, 2020.

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     SECTION 2. 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, and any

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

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under chapters 18, 19, 20, and 41 of title 27, shall provide coverage for the treatment of mental-

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health and substance-use disorders under the same terms and conditions as that coverage is

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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 and determining placements for substance-use

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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 coverage shall apply to medically necessary chiropractic care and

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

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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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     (j) Consistent with coverage for medical and surgical services, a health plan as defined in

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subsection (a) of this section shall cover clinically appropriate residential or inpatient services,

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including detoxification and stabilization services, for the treatment of mental health and

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substance use disorders, including alcohol use disorders, in accordance with this subsection. After

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an assessment for substance use disorders, including alcohol use disorders, based upon the criteria

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of the American Society of Addiction Medicine, or after an appropriate psychiatric assessment for

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mental health disorders, conducted upon an emergency admission or for continuation of care, if a

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qualified medical or clinical professional determines that residential or inpatient care, including

 

LC001231/SUB A/2 - Page 2 of 3

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

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

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four (24) hours prior to the expiration of any previous authorization from the health insurer,

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submit a treatment plan, including an estimated length of stay and such other information as may

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be reasonably requested by the health insurer, to the patient's health insurer. The health insurer

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shall conduct the utilization review in accordance with chapter 18.9 of title 27; provided, that the

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patient shall be and remain presumptively covered for residential or inpatient services, including

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detoxification and stabilization services, during the utilization review. On or before March l,

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2022, the senate committee on health and human services, in conjunction with the house

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committee on corporations, shall conduct a hearing on the impact of this subsection, to include

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presentations from payors and providers, and other stakeholders at the discretion of the committee

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chairs. This subsection shall apply only to covered services delivered within the health insurer's

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provider network. Nothing herein prohibits the group health plan or health insurer from

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conducting quality of care reviews.

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     SECTION 3. 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 HEALTH AND SAFETY - COMPREHENSIVE DISCHARGE PLANNING

***

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     This act would require each hospital and freestanding emergency-care facility to

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incorporate consent for a certified peer recovery specialist services into a comprehensive patient

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consent form, and further requires all contracts between health insurance carriers and the Rhode

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Island Medicaid program to cover clinically appropriate services for the treatment of mental

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health and substance abuse disorders.

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     This act would take effect on January 1, 2020.

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