Rhode Island 2023 Regular Session

Rhode Island Senate Bill S0028 Compare Versions

Only one version of the bill is available at this time.

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5	5	2023 -- S 0028
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7	7	LC000284
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9	9	S T A T E O F R H O D E I S L A N D
10	10	IN GENERAL ASSEMBLY
11	11	JANUARY SESSION, A.D. 2023
12	12	____________
13	13
14	14	A N A C T
15	15	RELATING TO INSURANCE -- INSURANCE COVERAGE FOR MENTAL ILLNESS AND
16	16	SUBSTANCE ABUSE
17	17	Introduced By: Senators Miller, DiPalma, DiMario, Valverde, Murray, and Lauria
18	18	Date Introduced: January 18, 2023
19	19	Referred To: Senate Health & Human Services
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22	22	It is enacted by the General Assembly as follows:
23	23	SECTION 1. Chapter 27-38.2 of the General Laws entitled "Insurance Coverage for Mental 1
24	24	Illness and Substance Abuse" is hereby amended by adding thereto the following section: 2
25	25	27-38.2-7. Reimbursement rate parity for mental health and substance use disorders. 3
26	26	(a) Every individual or group health insurance contract, plan or policy delivered, issued for 4
27	27	delivery or renewed in this state on or after January 1, 2024, shall increase the rate of reimbursement 5
28	28	for each in-network behavioral health care service that is reimbursed below the median commercial 6
29	29	reimbursement rate set by the office of the health insurance commissioner. The rate will increase 7
30	30	annually to no less than the median commercial reimbursement rate set by the office of the health 8
31	31	insurance commissioner on or before July 1, 2029. 9
32	32	(1) Median commercial insurance rates for each in-network behavioral health care service 10
33	33	shall be determined by the office of the health insurance commissioner. 11
34	34	(2) For rates lower than the median commercial reimbursement rate, incremental increases 12
35	35	towards the median commercial reimbursement rate must take place on an annual basis at a rate 13
36	36	determined by the office of the health insurance commissioner. 14
37	37	(3) Reimbursement rates that are at or above the median commercial reimbursement rate 15
38	38	for an in-network behavioral health care services shall not be decreased by a health insurer. 16
39	39	(b) Each health insurer shall collect and provide any information and data to the office of 17
40	40	the health insurance commissioner in a form and frequency acceptable to the office that is deemed 18
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44	44	necessary to uphold the requirements of this section. 1
45	45	(c) The office of the health insurance commissioner shall monitor how reimbursement rate 2
46	46	increases described in this section affect patient access to behavioral health care services, including, 3
47	47	but not limited to, any changes related to behavioral health network adequacy. On or before July 1, 4
48	48	2025, and on or before each July 1 thereafter, the office of the health insurance commissioner shall 5
49	49	report any changes to behavioral health care access and network adequacy to the general assembly 6
50	50	in writing. 7
51	51	(1) "Network", as used in this section, shall have the same meaning as is defined and used 8
52	52	in chapter 18.8 of this title. 9
53	53	(d) The office of the health insurance commissioner may promulgate such rules and 10
54	54	regulations as are necessary and proper to effectuate the purpose and for the efficient administration 11
55	55	and enforcement of this section. 12
56	56	(1) Should the office of the health insurance commissioner find that a health insurer is not 13
57	57	in compliance with the requirements found in this section, the office of the health insurance 14
58	58	commissioner’s authority shall include, but not be limited to, requiring a health insurer to complete 15
59	59	a corrective action plan. 16
60	60	SECTION 2. Chapter 42-7.2 of the General Laws entitled "Office of Health and Human 17
61	61	Services" is hereby amended by adding thereto the following section: 18
62	62	42-7.2-21. Reimbursement rate parity for mental health and substance use disorder. 19
63	63	(a) Effective January 1, 2024, Rhode Island Medicaid and its contracted managed care 20
64	64	entities shall increase the rate of reimbursement for each in-network behavioral health care service 21
65	65	that is reimbursed below the median commercial reimbursement rate set by the office of the health 22
66	66	insurance commissioner. The rate will increase annually to no less than the median commercial 23
67	67	reimbursement rate set by the office of the health insurance commissioner on or before July 1, 24
68	68	2029. 25
69	69	(1) Median commercial insurance rates for each in-network behavioral health care service, 26
70	70	as determined by the office of the health insurance commissioner in accordance with § 27-38.2-7, 27
71	71	shall be shared with the executive office of health and human services in accordance with § 42-7.2-28
72	72	14. 29
73	73	(2) For rates lower than the median commercial reimbursement rate determined in 30
74	74	accordance with subsection (a)(1) of this section, incremental increases towards the median 31
75	75	commercial reimbursement rate set by the office of health and human services must take place on 32
76	76	an annual basis at a rate determined by the executive office of health and human services. 33
77	77	(3) Reimbursement rates that are at or above the median commercial reimbursement rate 34
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81	81	for an in-network behavioral health care services shall not be decreased by Rhode Island Medicaid 1
82	82	or its contracted managed care entities. 2
83	83	(b) Each of Rhode Island Medicaid’s contracted managed care entities shall collect and 3
84	84	provide any information and data to the executive office of health and human services in a form 4
85	85	and frequency acceptable to the office that is deemed necessary to uphold the requirements of this 5
86	86	section. 6
87	87	(c) The executive office of health and human services shall monitor how reimbursement 7
88	88	rate increases described in this section affect patient access to behavioral health care services 8
89	89	including, but not limited to, any changes related to behavioral health network adequacy. On or 9
90	90	before July 1, 2025, and on or before each July 1 thereafter, the executive office of health and 10
91	91	human services shall report any changes to behavioral health care access and network adequacy to 11
92	92	the general assembly in writing. 12
93	93	(d) The executive office of health and human services is directed to ensure that federal 13
94	94	financial participation is used to the maximum extent allowable to provide coverage pursuant to 14
95	95	this section, and that state-only funds will be used only if federal financial participation is not 15
96	96	available. 16
97	97	(e) The executive office of health and human services may promulgate such rules and 17
98	98	regulations as are necessary and proper to effectuate the purpose and for the efficient administration 18
99	99	and enforcement of this section. 19
100	100	(1) Should the executive office of health and human services find that Rhode Island 20
101	101	Medicaid’s contracted managed care entities are not in compliance with the requirements found in 21
102	102	this section, the executive office of health and human services authority shall include, but not be 22
103	103	limited to, requiring a contracted managed care entity to complete a corrective action plan. 23
104	104	SECTION 3. This act shall take effect upon passage. 24
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111	111	EXPLANATION
112	112	BY THE LEGISLATIVE COUNCIL
113	113	OF
114	114	A N A C T
115	115	RELATING TO INSURANCE -- INSURANCE COVERAGE F OR MENTAL ILLNESS AND
116	116	SUBSTANCE ABUSE
117	117	***
118	118	This act would increase the rate of reimbursement for in-network behavioral health care 1
119	119	services below the median commercial reimbursement rate. In addition Rhode Island Medicaid 2
120	120	shall also increase the rate of reimbursement. 3
121	121	This act would take effect upon passage. 4
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