Senate Bill #789 (2017)

AN ACT RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

Requires insurance reimbursement for chiropractic diagnosis and treatment of conditions associated with the use of pain medications.

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Changes since original draft

  • 2017 – S 0789
  • 2017 – S 0789 SUBSTITUTE A AS AMENDED
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  • LC002439
  • LC002439/SUB A
  • ========
  • S T A T E O F R H O D E I S L A N D
  • IN GENERAL ASSEMBLY
  • JANUARY SESSION, A.D. 2017
  • ____________
  • A N A C T
  • RELATING TO INSURANCE – ACCIDENT AND SICKNESS INSURANCE POLICIES
  • Introduced By: Senators Lombardo, DiPalma, Nesselbush, Lynch Prata, and McCaffrey
  • Date Introduced: April 25, 2017
  • Referred To: Senate Health & Human Services
  • It is enacted by the General Assembly as follows:
  • SECTION 1. Chapter 27-18 of the General Laws entitled "Accident and Sickness Insurance Policies" is hereby amended by adding thereto the following section:
  • 27-18-48.2. Patient access to alternative medicine.
  • (a) Legislative purpose - Medications prescribed for the management of pain constitute a factor involved in the incidence of drug-related overdoses and deaths. The purpose of this section is to ensure patient access to alternative means of pain management, specifically, access to and reimbursement of medical services rendered by chiropractic physicians in the diagnosis and treatment of conditions associated with the usage of pain medications.
  • (b) Construction of health policies, plans and contracts. - Notwithstanding any other provision of law, when any health insurance policy, health care services plan, or other contract provides for the payment for medical expense benefits or procedures related to the treatment of pain, such policy, plan, or contract shall be construed to include equivalent payment to a chiropractic physician who provides the equivalent non-pharmaceutical medical service benefits or procedures which are within the scope of a chiropractic physician's license. Any limitation or condition placed upon services, diagnosis, treatment, or payments for pain conditions utilizing non-pharmaceutical interventions, by any licensed physician shall apply equally to all licensed physicians without unfair discrimination based upon the usual and customary treatment procedures of any class of physicians. Nothing in this section shall be construed as preventing a group health plan or a health insurance issuer from establishing varying reimbursement rates based on quality or performance measures; provided, however, that:
  • (1) Reimbursement may not be arbitrarily capped and must be based on medical necessity;
  • (2) Reimbursement rates must be set utilizing industry standard relative value scale metrics, including equivalent co-payments for equivalent levels of service delivered by any licensed provider group; and
  • (3) No discriminatory contractual terms may be imposed based upon whether the treating provider is an allopathic, osteopathic, or chiropractic physician.
  • (c) Enforcement. The office of the health insurance commissioner shall enforce the provisions of this section.
  • 27-18-25. Unfair discrimination prohibited.
  • Notwithstanding any provision of any policy of insurance, certificate, or service contract issued in this state, whenever the insurance policy, certificate, or service contract provides for reimbursement for any services which may be legally performed by any person licensed under the provisions of chapters 29, 30, 35 and 37 of title 5, reimbursement under the insurance policy, certificate, or service contract shall be based upon a determination of medical necessity and shall not be denied because of race, color, or creed, nor shall any insurer make or permit any unfair discrimination against particular individuals or persons licensed under chapters 29, 30, 35 and 37 of title 5.
  • SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service Corporations" is hereby amended by adding thereto the following section:
  • 27-19-40.2. Patient access to alternative medicine.
  • (a) Legislative purpose - Medications prescribed for the management of pain constitute a factor involved in the incidence of drug-related overdoses and deaths. The purpose of this section is to ensure patient access to alternative means of pain management, specifically, access to and reimbursement of medical services rendered by chiropractic physicians in the diagnosis and treatment of conditions associated with the usage of pain medications.
  • (b) Construction of health policies, plans and contracts. - Notwithstanding any other provision of law, when any health insurance policy, health care services plan, or other contract provides for the payment for medical expense benefits or procedures related to the treatment of pain, such policy, plan, or contract shall be construed to include equivalent payment to a chiropractic physician who provides the equivalent non-pharmaceutical medical service benefits or procedures which are within the scope of a chiropractic physician's license. Any limitation or condition placed upon services, diagnosis, treatment, or payments for pain conditions utilizing non-pharmaceutical interventions, by any licensed physician shall apply equally to all licensed physicians without unfair discrimination based upon the usual and customary treatment procedures of any class of physicians. Nothing in this section shall be construed as preventing a group health plan or a health insurance issuer from establishing varying reimbursement rates based on quality or performance measures; provided, however, that:
  • (1) Reimbursement may not be arbitrarily capped and must be based on medical necessity;
  • (2) Reimbursement rates must be set utilizing industry standard relative value scale metrics, including equivalent co-payments for equivalent levels of service delivered by any licensed provider group; and
  • (3) No discriminatory contractual terms may be imposed based upon whether the treating provider is an allopathic, osteopathic, or chiropractic physician.
  • (c) Enforcement. The office of the health insurance commissioner shall enforce the provisions of this section.
  • SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service Corporations" is hereby amended by adding thereto the following section:
  • 27-20-35.2 Patient access to alternative medicine.
  • (a) Legislative purpose - Medications prescribed for the management of pain constitute a factor involved in the incidence of drug-related overdoses and deaths. The purpose of this section is to ensure patient access to alternative means of pain management, specifically, access to and reimbursement of medical services rendered by chiropractic physicians in the diagnosis and treatment of conditions associated with the usage of pain medications.
  • (b) Construction of health policies, plans and contracts. - Notwithstanding any other provision of law, when any health insurance policy, health care services plan, or other contract provides for the payment for medical expense benefits or procedures related to the treatment of pain, such policy, plan, or contract shall be construed to include equivalent payment to a chiropractic physician who provides the equivalent non-pharmaceutical medical service benefits or procedures which are within the scope of a chiropractic physician's license. Any limitation or condition placed upon services, diagnosis, treatment, or payments for pain conditions utilizing non-pharmaceutical interventions, by any licensed physician shall apply equally to all licensed physicians without unfair discrimination based upon the usual and customary treatment procedures of any class of physicians. Nothing in this section shall be construed as preventing a group health plan or a health insurance issuer from establishing varying reimbursement rates based on quality or performance measures; provided, however, that:
  • (1) Reimbursement may not be arbitrarily capped and must be based on medical necessity;
  • (2) Reimbursement rates must be set utilizing industry standard relative value scale metrics, including equivalent co-payments for equivalent levels of service delivered by any licensed provider group; and
  • (3) No discriminatory contractual terms may be imposed based upon whether the treating provider is an allopathic, osteopathic, or chiropractic physician.
  • (c) Enforcement. The office of the health insurance commissioner shall enforce the provisions of this section.
  • SECTION 4. Chapter 27-41 of the General Laws entitled "Health Maintenance Organizations" is hereby amended by adding thereto the following section:
  • 27-41-49.2. Patient access to alternative medicine.
  • (a) Legislative purpose - Medications prescribed for the management of pain constitute a factor involved in the incidence of drug-related overdoses and deaths. The purpose of this section is to ensure patient access to alternative means of pain management, specifically, access to and reimbursement of medical services rendered by chiropractic physicians in the diagnosis and treatment of conditions associated with the usage of pain medications.
  • (b) Construction of health policies, plans and contracts. - Notwithstanding any other provision of law, when any health insurance policy, health care services plan, or other contract provides for the payment for medical expense benefits or procedures related to the treatment of pain, such policy, plan, or contract shall be construed to include equivalent payment to a chiropractic physician who provides the equivalent non-pharmaceutical medical service benefits or procedures which are within the scope of a chiropractic physician's license. Any limitation or condition placed upon services, diagnosis, treatment, or payments for pain conditions utilizing non-pharmaceutical interventions, by any licensed physician shall apply equally to all licensed physicians without unfair discrimination based upon the usual and customary treatment procedures of any class of physicians. Nothing in this section shall be construed as preventing a group health plan or a health insurance issuer from establishing varying reimbursement rates based on quality or performance measures; provided, however, that:
  • (1) Reimbursement may not be arbitrarily capped and must be based on medical necessity;
  • (2) Reimbursement rates must be set utilizing industry standard relative value scale metrics, including equivalent co-payments for equivalent levels of service delivered by any licensed provider group; and
  • (3) No discriminatory contractual terms may be imposed based upon whether the treating provider is an allopathic, osteopathic, or chiropractic physician.
  • (c) Enforcement. The office of the health insurance commissioner shall enforce the provisions of this section.
  • SECTION 5. This act shall take effect upon passage.
  • 27-19-74. Unfair discrimination prohibited.
  • Notwithstanding any provision of any policy of insurance, certificate, or service contract issued in this state, whenever the insurance policy, certificate, or service contract provides for reimbursement for any services which may be legally performed by any person licensed under the provisions of chapters 29, 30, 35 and 37 of title 5, reimbursement under the insurance policy, certificate, or service contract shall be based upon a determination of medical necessity and shall not be denied because of race, color, or creed, nor shall any insurer make or permit any unfair discrimination against particular individuals or persons licensed under chapters 29, 30, 35 and 37 of title 5.
  • SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service Corporations" is hereby amended by adding thereto the following section:
  • 27-20-70. Unfair discrimination prohibited.
  • Notwithstanding any provision of any policy of insurance, certificate, or service contract issued in this state, whenever the insurance policy, certificate, or service contract provides for reimbursement for any services which may be legally performed by any person licensed under the provisions of chapters 29, 30, 35 and 37 of title 5, reimbursement under the insurance policy, certificate, or service contract shall be based upon a determination of medical necessity and shall not be denied because of race, color, or creed, nor shall any insurer make or permit any unfair discrimination against particular individuals or persons licensed under chapters 29, 30, 35 and 37 of title 5.
  • SECTION 4. Chapter 27-41 of the General Laws entitled "Health Maintenance Organizations" is hereby amended by adding thereto the following section:
  • 27-41-87. Unfair discrimination prohibited.
  • Notwithstanding any provision of any policy of insurance, certificate, or service contract issued in this state, whenever the insurance policy, certificate, or service contract provides for reimbursement for any services which may be legally performed by any person licensed under the provisions of chapters 29, 30, 35 and 37 of title 5, reimbursement under the insurance policy, certificate, or service contract shall be based upon a determination of medical necessity and shall not be denied because of race, color, or creed, nor shall any insurer make or permit any unfair discrimination against particular individuals or persons licensed under chapters 29, 30, 35 and 37 of title 5.
  • SECTION 5. 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 and an individual or group health insurance plan shall provide coverage for the treatment of mental health and 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 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 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 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 treatment or medication-assisted maintenance services of substance-use disorders, opioid overdoses, and chronic addiction, including methadone, buprenorphine, naltrexone, or other clinically appropriate medications, 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.
  • (h) Patients with substance use disorders shall have access to evidence-based non-opioid treatment for pain, therefore coverage shall apply to medically necessary chiropractic care, and osteopathic manipulative treatment performed by an individual licensed under §5-37-2.
  • SECTION 6. This act shall take effect upon passage on April 1, 2018.
  • ========
  • LC002439
  • LC002439/SUB A
  • ========
  • EXPLANATION
  • BY THE LEGISLATIVE COUNCIL
  • OF
  • A N A C T
  • RELATING TO INSURANCE – ACCIDENT AND SICKNESS INSURANCE POLICIES
  • ***
  • This act would require insurance reimbursement for chiropractic diagnosis and treatment of conditions associated with the use of pain medications.
  • This act would take effect upon passage. ======== LC002439 ========
  • This act would require insurance reimbursement for medically necessary evidence-based chiropractic and osteopathic non-opioid treatments for pain.
  • This act would take effect upon passage on April 1, 2018. ======== LC002439/SUB A ========

Votes

NOTE: Electronic voting records are unofficial and may not be accurate. For an official vote tally, check the House or Senate Journal from the day of the vote.

Floor vote for Approval of Amendment

June 28, 2017 at 5:04pm
Yeas: 36 / Nays: 0 / Not voting: 1 / Recused: 0
Legislator Vote
Sen. Algiere Y
Sen. Archambault Y
Sen. Calkin Y
Sen. Ciccone Y
Sen. Conley Y
Sen. Cote Y
Sen. Coyne Y
Sen. Crowley Y
Sen. DaPonte Y
Sen. DiPalma Y
Sen. Doyle NV
Sen. Felag Y
Sen. Fogarty Y
Sen. Gallo Y
Sen. Gee Y
Sen. Goldin Y
Sen. Goodwin Y
Sen. Jabour Y
Sen. Kettle Y
Sen. Lombardi Y
Sen. Lombardo Y
Sen. Lynch Prata Y
Sen. McCaffrey Y
Sen. Metts Y
Sen. Miller Y
Sen. Morgan Y
Sen. Nesselbush Y
Sen. Paolino Y
Sen. Pearson Y
Sen. Picard Y
Sen. Quezada Y
Sen. Raptakis Y
Sen. Ruggerio Y
Sen. Satchell Y
Sen. Seveney Y
Sen. Sheehan Y
Sen. Sosnowski Y

Floor vote for Passage as Amended

June 28, 2017 at 5:04pm
Yeas: 36 / Nays: 0 / Not voting: 1 / Recused: 0
Legislator Vote
Sen. Algiere Y
Sen. Archambault Y
Sen. Calkin Y
Sen. Ciccone Y
Sen. Conley Y
Sen. Cote Y
Sen. Coyne Y
Sen. Crowley Y
Sen. DaPonte Y
Sen. DiPalma Y
Sen. Doyle NV
Sen. Felag Y
Sen. Fogarty Y
Sen. Gallo Y
Sen. Gee Y
Sen. Goldin Y
Sen. Goodwin Y
Sen. Jabour Y
Sen. Kettle Y
Sen. Lombardi Y
Sen. Lombardo Y
Sen. Lynch Prata Y
Sen. McCaffrey Y
Sen. Metts Y
Sen. Miller Y
Sen. Morgan Y
Sen. Nesselbush Y
Sen. Paolino Y
Sen. Pearson Y
Sen. Picard Y
Sen. Quezada Y
Sen. Raptakis Y
Sen. Ruggerio Y
Sen. Satchell Y
Sen. Seveney Y
Sen. Sheehan Y
Sen. Sosnowski Y

Floor vote for Passage In Concurrence

June 30, 2017 at 7:05pm
Yeas: 35 / Nays: 0 / Not voting: 2 / Recused: 0
Legislator Vote
Sen. Algiere Y
Sen. Archambault Y
Sen. Calkin Y
Sen. Ciccone Y
Sen. Conley Y
Sen. Cote Y
Sen. Coyne Y
Sen. Crowley NV
Sen. DaPonte Y
Sen. DiPalma Y
Sen. Doyle NV
Sen. Felag Y
Sen. Fogarty Y
Sen. Gallo Y
Sen. Gee Y
Sen. Goldin Y
Sen. Goodwin Y
Sen. Jabour Y
Sen. Kettle Y
Sen. Lombardi Y
Sen. Lombardo Y
Sen. Lynch Prata Y
Sen. McCaffrey Y
Sen. Metts Y
Sen. Miller Y
Sen. Morgan Y
Sen. Nesselbush Y
Sen. Paolino Y
Sen. Pearson Y
Sen. Picard Y
Sen. Quezada Y
Sen. Raptakis Y
Sen. Ruggerio Y
Sen. Satchell Y
Sen. Seveney Y
Sen. Sheehan Y
Sen. Sosnowski Y