Chapter 209

2015 -- S 0490 SUBSTITUTE A Enacted 07/10/2015

A N   A C T

RELATING TO INSURANCE - INSURANCE COVERAGE FOR MENTAL ILLNESS AND SUBSTANCE ABUSE

Introduced By: Senators Miller, Nesselbush, Sosnowski, Archambault, and Jabour

Date Introduced: February 26, 2015

It is enacted by the General Assembly as follows:

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

"Insurance Coverage for Mental Illness and Substance Abuse" is hereby amended to read as

follows:

27-38.2-1. Coverage for the treatment of mental health and substance use disorders.

-- (a) A group health plan, plan and an individual or group health insurance plan shall provide

coverage for the treatment of mental health and substance use substance-use disorders under the

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

(b) Coverage for the treatment of mental health and substance use substance-use

disorders shall not impose any annual or lifetime dollar limitation.

(c) Financial requirements and quantitative treatment limitations on coverage for the

treatment of mental health and substance use substance-use disorders shall be no more

restrictive than the predominant financial requirements applied to substantially all coverage for

medical conditions in each treatment classification.

(d) Coverage shall not impose non-quantitative treatment limitations for the treatment of

mental health and substance use substance-use disorders unless the processes, strategies,

evidentiary standards, or other factors used in applying the non-quantitative treatment limitation,

as written and in operation, are comparable to, and are applied no more stringently than, the

processes, strategies, evidentiary standards, or other factors used in applying the limitation with

respect to medical/surgical benefits in the classification.

(e) The following classifications shall be used to apply the coverage requirements of this

chapter: (1) Inpatient, in-network; (2) Inpatient, out-of-network; (3) Outpatient, in-network; (4)

Outpatient, out-of-network; (5) Emergency care; and (6) Prescription drugs.

(f) Medication-assisted therapy, including methadone maintenance services, for the

treatment of substance use substance-use disorders, opioid overdoses, and chronic addiction is

included within the appropriate classification based on the site of the service.

(g) Payors shall rely upon the criteria of the American Society of Addiction Medicine

when developing coverage for levels of care for substance-use disorder treatment.

SECTION 2. This act shall take effect upon passage.

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LC001670/SUB A

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