The bill addresses the issue of mental health and substance use disorder (SUD) treatment coverage by health insurers in Rhode Island. It cites a 2020 survey by the Substance Abuse and Mental Health Services Administration (SAMHSA) which found that a significant portion of US adults suffer from mental illness and SUDs, but a majority of them do not receive the necessary care. The bill references the Office of Health Insurance Commissioner's (OHIC) efforts to promote parity in health coverage and notes that Blue Cross Blue Shield of Rhode Island (BCBSRI) removed the need for prior approval for in-network mental health or SUD services in August 2018. The bill suggests that all health insurers in Rhode Island should follow BCBSRI's lead to ensure timely and medically necessary care for individuals with mental health and SUDs.

The bill amends Section 27-38.2-1 of the Rhode Island General Laws to ensure that coverage for mental health and SUD treatment is provided under the same terms as other medical conditions, without imposing any annual or lifetime dollar limitations. It specifies that financial requirements and treatment limitations for mental health and SUDs must not be more restrictive than those for medical conditions. The bill includes medication-assisted treatment services within the coverage and requires payors to use the American Society of Addiction Medicine criteria for developing coverage levels for SUD treatment. It also ensures access to non-opioid treatment for pain and parity in cost-sharing requirements for behavioral health counseling and medication maintenance visits. A significant insertion to the law is that health insurers in Rhode Island shall not require prior authorization for in-network mental health or SUD services, with the OHIC responsible for rulemaking, oversight, and enforcement, including imposing fines for violations. The act would take effect upon passage.

Statutes affected:
2393: 27-38.2-1