Rhode Island Legislation

SB 26 amends Section 27-38.2-1 of the General Laws to require group health plans and individual or group health insurance plans to provide at least 90 days of coverage for residential or inpatients services for the treatment of mental health and/or substance use disorders provided at ASAM levels of care 3.1 and 3.3.

Section 1 amends RI General Laws §5-37.3-4 to allow SUD providers to reveal a patient’s protected health information to an individual if the provider believes this will prevent or lessen serious or imminent threats to the patient and the individual being told is reasonably able to lessen or prevent such a threat.
Section 4 amends §27-38.2-1a to require any contract between the RI Medicaid program and any insurance carrier provide equitable coverage for mental health and substance use disorder treatment.
Additionally, S.2545 Sub A requires group health plans, individual or group health insurance plans, and contracts between the Rhode Island Medicaid program and any health insurance carrier to provide equitable coverage of clinically appropriate residential or inpatient care, including detoxification and stabilization services, for the treatment of mental health and substance use disorder. Further guidelines create timelines for utilization review in which treatment plans can be submitted by providers upon an emergency admission or continuation of care and reviewed by the insurer. During the utilization review process, the patient should remain presumptively covered for residential and inpatient services.

H.7476 amends RI General Laws §27-38.2-1 to require group health plans or health insurers to provide equitable coverage for clinically appropriate residential or inpatient care, including detoxification and stabilization services, for the treatment of mental health and substance use disorders. Further guidelines create timelines in which treatment plans can be submitted for utilization review by providers upon an emergency admission or continuation of care. During the utilization review process, the patient should remain presumptively covered for residential and inpatient services.

H.7931 amends RI General Laws §42-14.5-3 to require the Health Insurance Commissioner to make recommendations to the General Assembly concerning mental health parity compliance. Such recommendations should include strategies to reduce unreasonable prior authorization and utilization review requirements, remediation provisions, telemedicine reimbursement rates, and cost sharing methodologies.

H. 7810 amends RI General Laws to provide equitable coverage for annual pediatric mental health examinations when determined medically necessary and ordered by a physician for a child, 10 to 18 years old. H. 7810 amends RI General Laws §27-18-27.1, §27-19-18.1, §27-20-14.1, and §27-41-61.1 to apply the above to every individual or group hospital or medical expense insurance policy, individual or group hospital or medical services plan contract, nonprofit hospital/medical service corporation plan, or health maintenance organization contact.

H. 7623 amends RI General Law §27-38.2-2 to define the term “drug addiction” as a “chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences.” Additionally, H. 7623 amends §27-38.2-1 to include drug addiction in coverage requirements of said section for group health plans and individual or group health insurance plans.

H. 7359 amends RI General Laws by prohibiting insurers from imposing coinsurance charges on mental health and substance use disorder benefits.
H. 7359 amends RI General Laws §27-18-8, §27-19-7.2, §27-20-6.2, §27-41-29.2, §27-18-84, §27-19-76, §27-20-72, and §27-41-89 to apply the above to accident and sickness insurers, nonprofit hospital/medical service corporations, health maintenance organizations, individual or group hospital or medical expense insurance policy, or individual or group hospital or medical services plan contracts.
Section 5 amends §27-38.2-1 to exclude deductibles, copayments, and out of pocket maximums for mental health and substance use disorder benefits offered by group health plans and individual and group health insurance plans. It also requires quantitative treatment limitations be no more restrictive than those applied to medical conditions in each treatment classification.

S.2128 amends the RI General Laws §27-38.2-1 to require group health plans and individual or group health insurance plans provide coverage for at least 90 days of residential or inpatient services for mental health and SUD at specified ASAM levels of care.

This bill amends RI General Laws to include state licensed facilities that provide mental health and SUD services in the definition of health care providers for the purposes of prompt payment of health insurance claims. It also amends §27-18-61, §27-19-52, §27-20-47, and §27-41-64 to apply the above to accident and sickness insurance policies, nonprofit hospital/medical service corporations, and health maintenance organizations.

S.501 amends RI General Law §27-38.2-1 to prohibit group health plans and individual or group health insurance plans from denying continued residential or inpatient treatment coverage for mental health or substance use disorder services due to medical necessity criteria if the individual is currently in such treatment and the provider has recommended continued residential or inpatient treatment based upon a clinical assessment.

This bill amends the section of state insurance law about behavioral health coverage by requiring Medicaid managed care organizations to cover mental health and substance use disorders under the same terms and conditions as other conditions. Additionally, the bill requires the coverage of in-network residential or inpatient services, including detoxification and stabilization services, when deemed clinically appropriate by a qualified professional provided that the professional submits a treatment plan to the insurer.

Among other things, this bill amends the section of state insurance law about behavioral health coverage by prohibiting the use of financial requirements for behavioral health care.

This bill amends a section of state law by requiring the health insurance commissioner to submit to the general assembly recommendations to ensure better compliance with state mental health parity requirements. Such recommendations must include general insurer compliance, prior authorization and utilization review, telemedicine reimbursement rates, and cost sharing methodologies.

 This bill amends the section of state insurance law about behavioral health coverage by requiring coverage of at least 90 days of inpatient or residential services for mental health and/or substance use disorders for levels of care 3.1 and 3.3 as dictated by the American Society of Addiction Medicine (click here to learn about ASAM levels of care).

Summary: This bill amends the section of state insurance law about behavioral health coverage by specifying that providers must submit a treatment plan to insurers for the continued authorization of inpatient and residential behavioral health care but that individuals are still eligible for care during the authorization review process.

This bill amends the section of state insurance law about behavioral health coverage by prohibiting the denial of coverage for continued residential or inpatient treatment if the patient has been admitted or is in residential or inpatient services and the provider has recommended continued mental health treatment based on clinical assessment, or for substance use disorders, based on criteria by the America Society of Addiction Medicine.

This bill amends a section of state law about parity by requiring health plans not require the use of a non-deterrent opioid analgesic drug prior to use of an abuse-deterrent product. It also requires that all health plans contain at least one abuse-deterrent product option within their drug formularies.

This bill amends a section of state law that impacts small employer health plans. It requires that all premiums, rebates, and cost-sharing discounts resulting from the participation in programs for health promotion must comply with the Federal Parity Law.

This bill tries to change the section of the state insurance law about parity so that individuals do not have to use a non-abuse-deterrent opioid medication before they are prescribed an abuse-deterrent opioid medication.

This bill amends a section of the state insurance law about parity so that health insurers cannot deny continued residential or inpatient treatment for mental health or substance use disorder if the patient is already admitted to residential or inpatient treatment and the provider recommends continued treatment in the facility based upon criteria from the American Society of Addiction Medicine.

This was a comprehensive bill that attempted to ensure the appropriate use of behavioral health services. The bill included the following sections related to network adequacy:

• Health plans must offer at least one in-network hospital that can provide outpatient services
• 10% of all primary care providers must offer integrated behavioral health services
• Health plans must offer step down services

The bill also made the following amendments to the section of state law about coverage for the treatment of mental health and substance use disorders:

• It added that coverage for mental health, substance use, and behavioral health disorders must be under the same terms and conditions as any other illness, particularly illnesses commonly treatment in primary care settings
• It extended the definition of mental health or substance use disorders to include any health-related behavior identified by the director of health as having an effect on health, illness, disease or function, and that substantially limits an individual’s life activities
• It added that medical necessity determinations must be made in a manner consistent with determinations used for other diseases, particularly illnesses commonly treated in primary care settings

The bill also requires the Office of the Health Insurance Commission to submit a report on how to improve compliance with the parity section of state law. The report can include sections on the following areas:

• Provider payment strategies focusing on cost effective utilization of service, such as step down and diversion programs
• Benefit design
• New health care technology

The bill also required that copayments for behavioral health office visits must be equal to copayments for non-preventative primary care office visits.

This comprehensive bill tried to change law in a number of ways relevant to parity:

• Requires insurance plans to cover all screening and diagnostic services for behavioral health conditions
• Allows the Director of the Department of Health to review plans’ utilization review procedures for behavioral health services to make sure that they are the same as those used for other medical services
• Requires plans to use copayments for behavioral health services that are equal to “non-preventive primary care” office visit copayments
• Specifies that “mental illness coverage” includes services from a behavioral health provider in a medical facility
• Directs the Health Insurance Commissioner to enforce the Federal Parity Law

This bill tried to change the section of the state insurance law about parity in several ways:

• Makes it clear that behavioral health coverage must be equivalent to coverage for other medical services including prescription medication formularies,financial requirements, and treatment limitations
• Requires plans to use medical necessity standards for behavioral health services that are “no more stringent” than those used for other medical services

This bill tried to change the section of the state insurance law about parity. It would have required plans to cover the following prescription medications for substance use disorder treatment:

• Naloxone
• Methadone
• Suboxone
• Naltrexone
• Buprenorphine

The bill also would have required the Health Insurance Commissioner to annually assess insurance plans’ compliance with these prescription medication coverage requirements.

The bill also tried to add another section to the state insurance law establishing standards for hospitals to follow when they discharge patients with substance use disorders.

This bill amended a section to the state insurance code by prohibiting health insurers from the following activities:

• Requiring individuals use an opioid drug not approved by the FDA prior to using a non-opioid drug approved by the FDA
• Requiring individuals use a non-abuse deterrent opioid prior to an abuse-deterrent opioid

This bill tried to change the section of the state insurance law about parity so that insurance plans would have to use the same criteria for determining reimbursement rates for behavioral health providers as the use for other medical providers.

This bill tried to change the section of the state insurance law about parity in the following ways:

• Requires plans to use the same criteria for determining reimbursement rates for behavioral health providers as the use for other medical providers
• Removes language that exempted plans from covering methadone maintenance treatment for substance use disorders
• Removes 30 day outpatient visit annual limit for behavioral health services
• Removes 30 hour outpatient visit annual limit for substance use disorders along with 30 day annual limit for residential treatment and 30 day detoxification annual limit
• Removes section requiring that all services take place within Rhode Island
• Allows the Commissioner of Health Insurance to issue regulations about this section of the law
• Requires the Commissioner of Health Insurance to make sure all state regulations are in compliance with what is required by the Federal Parity Law

(Many of these changes did in fact take place in later sessions and those changes are reflected in the summaries of relevant sections of Rhode Island law found at the bottom of this page under “Rhode Island Parity Law”.

This bill tried to change the section of the state insurance law about parity so that insurance plans would have to use the same criteria for determining reimbursement rates for mental health providers as they use for other medical providers.

This bill tried to change the section of the state insurance law about autism coverage to require coverage for psychiatry, psychology, and pharmaceutical services. The bill also tried to change some credentialing requirements for providers of applied behavioral analysis. In terms of how it would have affected the law about autism coverage, it is exactly the same as H 7165/S 2560 from the same session, which became law (summarized above).

This bill tried to change the section of the state insurance law about parity so that insurance plans would have to use the same criteria for determining reimbursement rates for mental health providers as the use for other medical providers. Under no circumstances can mental health providers be reimbursed less than other medical providers of a similar level with similar expertise.

This bill tried to add a section about autism coverage to the state insurance law. Here is how the bill is different than the current section of the insurance law about autism coverage, which was added in 2011 and is summarized at the bottom of this page:

• Applies to small employer fully-insured plans and individual plans
• Goes into much greater detail defining various forms of treatment
• Lists “habilitative and rehabilitative care” and “therapeutic care” instead of “physical therapy”, “speech therapy”, and “occupational therapy”
• Defines autism spectrum disorder as autistic disorder Asperger’s disorder, and pervasive developmental disorder not otherwise specified, as defined in the DSM
• No annual maximum for applied behavior analysis
• No age limit for coverage
• Forbids annual limits for outpatient visits
• Does not have any language about how often an insurance plan can review a child’s treatment plan

Among other things, this bill tried to add a section about autism coverage to the state insurance law. Here is how the bill is different than the current section of the insurance law about autism coverage, which was added in 2011 and is summarized at the bottom of this page:

• Applies to small employer fully-insured plans and individual plans
• Defines autism spectrum disorder as a neurological disorder and specifically “not a mental illness”; does not mention DSM in this definition
• No annual maximum for applied behavior analysis
• No age limit for coverage
• Does not have any listing of what qualifies as autism treatment

This bill tried to change the section of the state insurance law about parity so that it specifically includes eating disorders (even though the law as written then and now does require plans to cover eating disorders).

This bill amended the state insurance law by requiring all health insurers cover services provided by nurse practitioners and psychiatric and mental health nurse clinical specialists. This bill is similar to H5537 and S 471 from the same legislative session.