2022 -- H 7861

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LC005302

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2022

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A N   A C T

RELATING TO INSURANCE -- INSURANCE COVERAGE FOR MENTAL ILLNESS AND

SUBSTANCE ABUSE

     Introduced By: Representatives Tanzi, Felix, McGaw, Ajello, Batista, Ranglin-Vassell,
Donovan, Shallcross Smith, Cortvriend, and Kislak

     Date Introduced: March 04, 2022

     Referred To: House Finance

     It is enacted by the General Assembly as follows:

     SECTION 1. Chapter 27-38.2 of the General Laws entitled "Insurance Coverage for Mental

Illness and Substance Abuse" is hereby amended by adding thereto the following section:

     27-38.2-6. Reimbursement rate parity for mental health and substance use disorders.

     (a) Every individual or group health insurance contract, plan or policy delivered, issued for

delivery or renewed in this state on or after January 1, 2023, shall increase the rate of reimbursement

for each in-network behavioral health care service that is reimbursed below the median commercial

reimbursement rate set by the office of the health insurance commissioner. The rate will increase

annually to no less than the median commercial reimbursement rate set by the office of the health

insurance commissioner on or before July 1, 2028.

     (1) Median commercial insurance rates for each in-network behavioral health care service

shall be determined by the office of the health insurance commissioner.

     (2) For rates lower than the median commercial reimbursement rate, incremental increases

towards the median commercial reimbursement rate must take place on an annual basis at a rate

determined by the office of the health insurance commissioner.

     (3) Reimbursement rates that are at or above the median commercial reimbursement rate

for an in-network behavioral health care services shall not be decreased by a health insurer.

     (b) Each health insurer shall collect and provide any information and data to the office of

the health insurance commissioner in a form and frequency acceptable to the office that is deemed

necessary to uphold the requirements of this section.

     (c) The office of the health insurance commissioner shall monitor how reimbursement rate

increases described in this section affect patient access to behavioral health care services, including,

but not limited to, any changes related to behavioral health network adequacy. On or before July 1,

2024, and on or before each July 1 thereafter, the office of the health insurance commissioner shall

report any changes to behavioral health care access and network adequacy to the general assembly

in writing.

     (1) "Network", as used in this section, shall have the same meaning as is defined and used

in chapter 18.8 of this title.

     (d) The office of the health insurance commissioner may promulgate such rules and

regulations as are necessary and proper to effectuate the purpose and for the efficient administration

and enforcement of this section.

     (1) Should the office of the health insurance commissioner find that a health insurer is not

in compliance with the requirements found in this section, the office of the health insurance

commissioner’s authority shall include, but not be limited to, requiring a health insurer to complete

a corrective action plan.

     SECTION 2. Chapter 42-7.2 of the General Laws entitled "Office of Health and Human

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

     42-7.2-21. Reimbursement rate parity for mental health and substance use disorder.

     (a) Effective January 1, 2023, Rhode Island Medicaid and its contracted managed care

entities shall increase the rate of reimbursement for each in-network behavioral health care service

that is reimbursed below the median commercial reimbursement rate set by the office of the health

insurance commissioner. The rate will increase annually to no less than the median commercial

reimbursement rate set by the office of the health insurance commissioner on or before July 1,

2028.

     (1) Median commercial insurance rates for each in-network behavioral health care service,

as determined by the office of the health insurance commissioner in accordance with § 27-38.2-6,

shall be shared with the executive office of health and human services in accordance with § 42-7.2-

14.

     (2) For rates lower than the median commercial reimbursement rate determined in

accordance with subsection (a)(1) of this section, incremental increases towards the median

commercial reimbursement rate set by the office of health and human services must take place on

an annual basis at a rate determined by the executive office of health and human services.

     (3) Reimbursement rates that are at or above the median commercial reimbursement rate

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for an in-network behavioral health care services shall not be decreased by Rhode Island Medicaid

or its contracted managed care entities.

     (b) Each of Rhode Island Medicaid’s contracted managed care entities shall collect and

provide any information and data to the executive office of health and human services in a form

and frequency acceptable to the office that is deemed necessary to uphold the requirements of this

section.

     (c) The executive office of health and human services shall monitor how reimbursement

rate increases described in this section affect patient access to behavioral health care services

including, but not limited to, any changes related to behavioral health network adequacy. On or

before July 1, 2024, and on or before each July 1 thereafter, the executive office of health and

human services shall report any changes to behavioral health care access and network adequacy to

the general assembly in writing.

     (d) The executive office of health and human services is directed to ensure that federal

financial participation is used to the maximum extent allowable to provide coverage pursuant to

this section, and that state-only funds will be used only if federal financial participation is not

available.

     (e) The executive office of health and human services may promulgate such rules and

regulations as are necessary and proper to effectuate the purpose and for the efficient administration

and enforcement of this section.

     (1) Should the executive office of health and human services find that Rhode Island

Medicaid’s contracted managed care entities are not in compliance with the requirements found in

this section, the executive office of health and human services authority shall include, but not be

limited to, requiring a contracted managed care entity to complete a corrective action plan.

     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 INSURANCE -- INSURANCE COVERAGE FOR MENTAL ILLNESS AND

SUBSTANCE ABUSE

***

     This act would increase the rate of reimbursement for in-network behavioral health care

services below the medial commercial reimbursement rate. In addition Rhode Island Medicaid shall

also increase the rate of reimbursement.

     This act would take effect upon passage.

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