It is enacted by the General Assembly as follows:

SECTION 1. Title 27 of the General Laws entitled "Insurance" is hereby amended by adding thereto the following chapter:

{ADD 27-38.2-1. Mental illness coverage. -- ADD} {ADD Every health care insurer shall provide coverage for the medical treatment of serious mental illness under the same terms and conditions as such coverage is provided for other illnesses and diseases. Insurance coverage offered pursuant to this statute must include the same durational limits, amount limits, deductibles, and co-insurance factors for serious mental illness as for other illnesses and diseases. ADD}

{ADD 27-38.2-2. Definitions. -- ADD} {ADD For the purposes of this chapter, the following words and terms shall have the following meanings:

(a) "Health insurers" means all persons, firms, corporations, or other organizations offering and assuring health services on a prepaid or primarily expense-incurred basis, including but not limited to policies of accident or sickness insurance, as defined by chapter 18 of this title, nonprofit hospital or medical service plans, whether organized under chapter 19 or 20 of this title or under any public law or by special act of the general assembly, health maintenance organizations, or any other entity which insures or reimburses for diagnostic, therapeutic, or preventive services to a determined population on the basis of a periodic premium, except for supplemental policies which only provide coverage for specified diseases.

(b) "Serious mental illness" means any mental disorder that current medical science affirms is caused by a biological disorder of the brain and that substantially limits the life activities of the person with the illness. The term includes, but is not limited to:

(1) schizophrenia

(2) schizoaffective disorder

(3) delusional disorder

(4) bipolar affective disorders

(5) major depression

(6) obsessive compulsive disorder.

(c) "Medical coverage" means inpatient hospitalization and outpatient medication visits. ADD}

{ADD 27-38.2-3. Medical necessity and appropriateness of treatment. -- ADD} {ADD Upon request of the reimbursing health insurers, all providers of treatment of serious mental illness shall furnish medical records or other necessary data which substantiates that initial or continued treatment is at all times medically necessary and appropriate. When the provider cannot so establish the medical necessity and/or appropriateness of the treatment modality being provided, neither the health insurer nor the patient shall be obligated to reimburse for that period or type of care which was not so established. The exception to the preceding can only be made if the patient has been informed of the above and has agreed in writing to continue to receive treatment at his or her own expense.

The health insurers, when making the above determination of medically necessary and appropriate treatment, must do so in a manner consistent with that used to make the determination for the treatment of other diseases or injuries covered under the health insurance policy or agreement. ADD}

{ADD 27-38.2-4. Limitations of coverage. -- ADD} {ADD The health care benefits outlined in this chapter apply only to services delivered within the state of Rhode Island.

Inpatient coverage in cases where continuous hospitalization is medically necessary shall be limited to ninety (90) consecutive days. ADD}

SECTION 2. This act shall take effect on January 1, 1995, and shall apply to policies issued, renewed or in effect on or after January 1, 1995.