2023 -- H 5347

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LC000837

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2023

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A N   A C T

RELATING TO INSURANCE -- INSURANCE COVERAGE FOR MENTAL ILLNESS AND

SUBSTANCE ABUSE

     

     Introduced By: Representative Joseph J. Solomon

     Date Introduced: February 03, 2023

     Referred To: House Health & Human Services

     It is enacted by the General Assembly as follows:

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     SECTION 1. Section 27-38.2-1 of the General Laws in Chapter 27-38.2 entitled "Insurance

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Coverage for Mental Illness and Substance Abuse" is hereby amended to read as 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/or substance use disorders under the same terms

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and conditions as that coverage is provided for other illnesses and diseases.

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     (b) Coverage for the treatment of mental health and/or 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/or 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/or 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; (6) Crisis stabilization medications; and (6)(7)

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Prescription drugs.

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     (f) Medication-assisted treatment or medication-assisted maintenance services of substance

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use disorders, opioid overdoses, and chronic addiction, including methadone, all federally approved

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medications, buprenorphine, naltrexone, or other clinically appropriate medications, is included

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within the 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 when

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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 coverage shall apply to medically necessary chiropractic care and

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osteopathic manipulative treatment performed by an individual licensed under § 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 plan’s

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credentialing and contracting provisions, cost-sharing for behavioral health counseling visits and

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

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office visits.

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     (j) The coverage required by this section shall include a minimum of ninety (90) days of

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residential or inpatient services for mental health and/or substance use disorders for American

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Society of Addiction Medicine levels of care 3.1 and 3.3.

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     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 require insurance coverage for a minimum of ninety (90) days of residential

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or inpatient services for mental health and/or substance use disorders for American Society of

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Addiction Medicine levels of care 3.1 and 3.3.

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     This act would take effect upon passage.

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LC000837

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