2023 -- H 5347
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LC000837
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S TATE OF RHODE IS LAND
IN GENERAL ASSEMBLY
JANUARY SESSION, A.D. 2023
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A N A C T
RELATING TO INSURANCE -- INSURANCE COVERAGE FOR MENTAL ILLNESS AND
SUBSTANCE ABUSE
Introduced By: Representative Joseph J. Solomon
Date Introduced: February 03, 2023
Referred To: House Health & Human Services
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 1
Coverage for Mental Illness and Substance Abuse" is hereby amended to read as follows: 2
27-38.2-1. Coverage for treatment of mental health and substance use disorders. 3
(a) A group health plan and an individual or group health insurance plan shall provide 4
coverage for the treatment of mental health and/or substance use disorders under the same terms 5
and conditions as that coverage is provided for other illnesses and diseases. 6
(b) Coverage for the treatment of mental health and/or substance use disorders shall not 7
impose any annual or lifetime dollar limitation. 8
(c) Financial requirements and quantitative treatment limitations on coverage for the 9
treatment of mental health and/or substance use disorders shall be no more restrictive than the 10
predominant financial requirements applied to substantially all coverage for medical conditions in 11
each treatment classification. 12
(d) Coverage shall not impose non-quantitative treatment limitations for the treatment of 13
mental health and/or substance use disorders unless the processes, strategies, evidentiary standards, 14
or other factors used in applying the non-quantitative treatment limitation, as written and in 15
operation, are comparable to, and are applied no more stringently than, the processes, strategies, 16
evidentiary standards, or other factors used in applying the limitation with respect to 17
medical/surgical benefits in the classification. 18
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(e) The following classifications shall be used to apply the coverage requirements of this 1
chapter: (1) Inpatient, in-network; (2) Inpatient, out-of-network; (3) Outpatient, in-network; (4) 2
Outpatient, out-of-network; (5) Emergency care; (6) Crisis stabilization medications; and (6)(7) 3
Prescription drugs. 4
(f) Medication-assisted treatment or medication-assisted maintenance services of substance 5
use disorders, opioid overdoses, and chronic addiction, including methadone, all federally approved 6
medications, buprenorphine, naltrexone, or other clinically appropriate medications, is included 7
within the appropriate classification based on the site of the service. 8
(g) Payors shall rely upon the criteria of the American Society of Addiction Medicine when 9
developing coverage for levels of care for substance use disorder treatment. 10
(h) Patients with substance use disorders shall have access to evidence-based, non-opioid 11
treatment for pain, therefore coverage shall apply to medically necessary chiropractic care and 12
osteopathic manipulative treatment performed by an individual licensed under § 5-37-2. 13
(i) Parity of cost-sharing requirements. Regardless of the professional license of the 14
provider of care, if that care is consistent with the provider’s scope of practice and the health plan’s 15
credentialing and contracting provisions, cost-sharing for behavioral health counseling visits and 16
medication maintenance visits shall be consistent with the cost-sharing applied to primary care 17
office visits. 18
(j) The coverage required by this section shall include a minimum of ninety (90) days of 19
residential or inpatient services for mental health and/or substance use disorders for American 20
Society of Addiction Medicine levels of care 3.1 and 3.3. 21
SECTION 2. This act shall take effect upon passage. 22
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LC000837
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LC000837 - Page 3 of 3
EXPLANATION
BY THE LEGISLATIVE COUNCIL
OF
A N A C T
RELATING TO INSURANCE -- INSURANCE COVERAGE F OR MENTAL ILLNESS AND
SUBSTANCE ABUSE
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This act would require insurance coverage for a minimum of ninety (90) days of residential 1
or inpatient services for mental health and/or substance use disorders for American Society of 2
Addiction Medicine levels of care 3.1 and 3.3. 3
This act would take effect upon passage. 4
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LC000837
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