Chapter 236
2015 -- H 5837 SUBSTITUTE A
Enacted 07/10/2015

A N   A C T
RELATING TO INSURANCE - INSURANCE COVERAGE FOR MENTAL ILLNESS AND SUBSTANCE ABUSE

Introduced By: Representatives Serpa, Palangio, Fellela, Melo, and McNamara
Date Introduced: March 11, 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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LC002069/SUB A
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