Rhode Island 2025 Regular Session

Rhode Island Senate Bill S0054 Compare Versions

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

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5	5	2025 -- S 0054
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7	7	LC000191
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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. 2025
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14	14	A N A C T
15	15	RELATING TO INSURANCE -- INSURANCE COVERAGE FOR MENTAL ILLNESS AND
16	16	SUBSTANCE USE DISORDERS
17	17	Introduced By: Senators Ujifusa, Murray, Euer, Pearson, Valverde, Lawson, Bell, Mack,
18	18	DiMario, and Vargas
19	19	Date Introduced: January 23, 2025
20	20	Referred To: Senate Health & Human Services
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23	23	It is enacted by the General Assembly as follows:
24	24	SECTION 1. Legislative findings. 1
25	25	(1) A 2020 survey by the Substance Abuse and Mental Health Services Administration 2
26	26	(SAMHSA), the agency within the U.S. Department of Health and Human Services that leads 3
27	27	public health efforts to advance the behavioral health of the nation, found: 4
28	28	(i) Approximately 21% of US adults aged 18 or older had mental illness, and 14.5% of 5
29	29	individuals aged 12 or older had a Substance Use Disorder (SUD) in the previous year. 6
30	30	(ii) Of the adults with mental illness, only 46.2% received mental health care. 7
31	31	(iii) Of those with SUDs, only 6.5% received treatment. 8
32	32	(2) The Office of Health Insurance Commissioner (OHIC) has worked with state insurers 9
33	33	to promote parity and in August 2018, Blue Cross Blue Shield of Rhode Island (BCBSRI) agreed 10
34	34	prior approval was no longer needed for in-network mental health or substance use disorder 11
35	35	services. 12
36	36	(3) To ensure Rhode Islanders with mental health and substance use disorders, get timely, 13
37	37	medically necessary care, all health insurers in Rhode Island should implement the prior 14
38	38	authorization policies that BCBSRI implemented in August 2018. 15
39	39	SECTION 2. Section 27-38.2-1 of the General Laws in Chapter 27-38.2 entitled "Insurance 16
40	40	Coverage for Mental Illness and Substance Use Disorders" is hereby amended to read as follows: 17
41	41	27-38.2-1. Coverage for treatment of mental health and substance use disorders. 18
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44	44	LC000191 - Page 2 of 4
45	45	(a) A group health plan and an individual or group health insurance plan shall provide 1
46	46	coverage for the treatment of mental health and substance use disorders under the same terms and 2
47	47	conditions as that coverage is provided for other illnesses and diseases. 3
48	48	(b) Coverage for the treatment of mental health and substance use disorders shall not 4
49	49	impose any annual or lifetime dollar limitation. 5
50	50	(c) Financial requirements and quantitative treatment limitations on coverage for the 6
51	51	treatment of mental health and substance use disorders shall be no more restrictive than the 7
52	52	predominant financial requirements applied to substantially all coverage for medical conditions in 8
53	53	each treatment classification. 9
54	54	(d) Coverage shall not impose non-quantitative treatment limitations for the treatment of 10
55	55	mental health and substance use disorders unless the processes, strategies, evidentiary standards, 11
56	56	or other factors used in applying the non-quantitative treatment limitation, as written and in 12
57	57	operation, are comparable to, and are applied no more stringently than, the processes, strategies, 13
58	58	evidentiary standards, or other factors used in applying the limitation with respect to 14
59	59	medical/surgical benefits in the classification. 15
60	60	(e) The following classifications shall be used to apply the coverage requirements of this 16
61	61	chapter: (1) Inpatient, in-network; (2) Inpatient, out-of-network; (3) Outpatient, in-network; (4) 17
62	62	Outpatient, out-of-network; (5) Emergency care; and (6) Prescription drugs. 18
63	63	(f) Medication-assisted treatment or medication-assisted maintenance services of substance 19
64	64	use disorders, opioid overdoses, and chronic addiction, including methadone, buprenorphine, 20
65	65	naltrexone, or other clinically appropriate medications, is included within the appropriate 21
66	66	classification based on the site of the service. 22
67	67	(g) Payors shall rely upon the criteria of the American Society of Addiction Medicine when 23
68	68	developing coverage for levels of care for substance use disorder treatment. 24
69	69	(h) Patients with substance use disorders shall have access to evidence-based, non-opioid 25
70	70	treatment for pain, therefore coverage shall apply to medically necessary chiropractic care and 26
71	71	osteopathic manipulative treatment performed by an individual licensed under § 5-37-2. 27
72	72	(i) Parity of cost-sharing requirements. Regardless of the professional license of the 28
73	73	provider of care, if that care is consistent with the provider’s scope of practice and the health plan’s 29
74	74	credentialing and contracting provisions, cost sharing for behavioral health counseling visits and 30
75	75	medication maintenance visits shall be consistent with the cost sharing applied to primary care 31
76	76	office visits. 32
77	77	(j) No health insurers in Rhode Island shall require prior authorization, for in-network 33
78	78	mental health or substance use disorder services. The office of the health insurance commissioner 34
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82	82	shall promulgate rules and regulations and conduct oversight and enforcement actions necessary to 1
83	83	implement this subsection, including the imposition of fines for violations. 2
84	84	SECTION 3. This act shall take effect upon passage. 3
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90	90	LC000191 - Page 4 of 4
91	91	EXPLANATION
92	92	BY THE LEGISLATIVE COUNCIL
93	93	OF
94	94	A N A C T
95	95	RELATING TO INSURANCE -- INSURANCE COVERAGE FOR MENT AL ILLNESS AND
96	96	SUBSTANCE USE DISORDERS
97	97	***
98	98	This act would prohibit health insurance providers from requiring preauthorization for in- 1
99	99	network mental health or substance use disorder services. 2
100	100	This act would take effect upon passage. 3
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