The bill introduces amendments to the General Laws concerning health insurance rates and coverage, particularly focusing on mental health and substance use disorders. It prohibits insurance companies that merge with or acquire non-profit hospital service corporations, non-profit medical service corporations, or health maintenance organizations from setting rates that include the value of contributions to associated charitable foundations. Additionally, these companies must pay rates not lower than the Medicaid rates approved by the executive office of health and human services and must provide documentation to the commissioner of insurance to demonstrate compliance with the cost structure of the rate.

The bill also seeks to ensure parity in insurance coverage for mental health and substance use disorders by requiring that coverage terms and limitations be no more restrictive than those for medical conditions. It mandates the inclusion of medication-assisted treatment and reliance on the American Society of Addiction Medicine criteria for coverage levels. The bill aims to provide patients with access to non-opioid treatments for pain and requires that reimbursement rates for providers of mental health and substance use disorders be at least equal to Medicaid rates. The act is scheduled to take effect on January 1, 2025.

Statutes affected:
2726  SUB A: 27-18-54, 27-19-30.1, 27-20-25.2, 27-38.2-1, 27-41-27.2
2726: 27-18-54, 27-19-30.1, 27-20-25.2, 27-41-27.2