2015 -- H 5837 SUBSTITUTE A

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LC002069/SUB A

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2015

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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

     Referred To: House Corporations

     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

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

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follows:

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     27-38.2-1. Coverage for the 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 substance use disorders under the same terms and

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

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      (b) Coverage for the treatment of mental health and 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 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 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; and (6) Prescription drugs.

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

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

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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

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

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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 payors providing insurance coverage for the treatment of mental

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health and substance abuse disorders to rely upon criteria of the American Society of Addiction

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

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     This act would take effect upon passage.

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