Senate Bill #329 (2017)

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

Provides that patients with mental health and/or substance-use disorders are presumptively eligible for emergency admission practices, including any appropriate inpatient services.

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Changes since original draft

  • 2017 – S 0329
  • 2017 – S 0329 SUBSTITUTE A
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  • LC001270
  • LC001270/SUB A
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  • S TATE OF RHODE IS L AND
  • IN GENERAL ASSEMBLY
  • JANUARY SESSION, A.D. 2017
  • ____________
  • A N A C T
  • 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 – INSURANCE COVERAGE FOR MENTAL ILLNESS AND
  • SUBSTANCE ABUSE
  • SUBSTANCE ABUSE
  • Introduced By: Senators Miller, Goldin, Satchell, Sosnowski, and Goodwin
  • Date Introduced: February 16, 2017
  • Referred To: Senate Health & Human Services
  • It is enacted by the GeneralAssembly 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 forthe treatment ofmentalhealthandsubstance use disorders.
  • (a) A group health plan and an individual or group health insurance plan shall provide coverage for the treatmentof 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.
  • 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 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) Consistent with coverage for medical and surgical services, patients with mental health and/or substance-use disorders are presumptively eligible for emergency admission practices, including any appropriate inpatient services. After an appropriate psychiatric assessment, if a qualified medical professional determines that continued residential or inpatient care is necessary care for a patient, that professional will submit a treatment plan, including an estimated length of stay, to the patient's payor for authorization of payment. A patient willremain presumptively eligible for residential or inpatient services during the payment authorization period. The office of the health insurance commissioner shall promulgate regulations that define reasonable payment authorization procedures and timelines for payors.
  • (h) Consistent with coverage for medical and surgical services, patients with mental health and/or substance-use disorders are presumptively eligible for emergency admission practices, including any appropriate inpatient services. After an appropriate psychiatric assessment, if a qualified medical professional determines that continued residential or inpatient care is clinically necessary care for a patient, that professional will submit a treatment plan, including an estimated length of stay, to the patient's payor for authorization of payment. A patient will remain presumptively eligible for residential or inpatient services during the payment authorization period. The office of the health insurance commissioner shall promulgate regulations that define reasonable payment authorization procedures and timelines for payors.
  • SECTION 2. This act shall take effect upon passage.
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  • LC001270
  • LC001270/SUB A
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  • LC001270 - Page 2of 3
  • EXPLANATION
  • BY THE LEGISLATIVE COUNCIL
  • OF
  • A N A C T RELATING TO INSURANCE – INSURANCE COVERAGE FOR MENTAL ILLNESS AND
  • EXPLANATION
  • BY THE LEGISLATIVE COUNCIL
  • OF
  • A N A C T
  • RELATING TO INSURANCE – INSURANCE COVERAGE FOR MENTAL ILLNESS AND
  • SUBSTANCE ABUSE
  • ***
  • This act would provide that patients with mental health and/or substance-use disorders are presumptively eligible for emergency admission practices, including any appropriate inpatient services.
  • This act would take effect upon passage. ======== LC001270 ========
  • LC001270 - Page 3of 3
  • This act would take effect upon passage. ======== LC001270/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 Passage

April 27, 2017 at 5:08pm
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 Y
Sen. DaPonte Y
Sen. DiPalma Y
Sen. Doyle NV
Sen. Felag Y
Sen. Fogarty Y
Sen. Gallo NV
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