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Legislation Signed into Law

2019

Primary Focus: Parity – General
Title/Description: Powers and Duties
Citation: R.I. General Laws § 42-14.5-3
Summary: Requires the Office of the Health Insurance Commissioner to:
– Conduct analysis of provisions of above’s impact on health insurance premiums and access to care and report findings to general assembly
– Ensure parity and integrate requirements into OHIC insurance oversight and health care transformation efforts
– Direct insurers toward policies and practices that address the behavioral health needs of the public and greater integration of physical and behavioral health care delivery
– Work with other agencies to make delivery system improvements that enhance access to a continuum of MH/SUD treatment;
Effective Date: June 1, 2019
Notes: Amended by R.I. HB 2540.

2018

Primary Focus: Parity – General
Title/Description: Parity in cost sharing requirements for counseling visits and MAT maintenance visits
Citation: R.I. Gen. Laws § 27-38.2-1
Summary: The statute requires counseling and MAT maintenance visits to be considered primary care visits for purposes of cost sharing requirements, regardless of professional license, if such care is consistent with the provider’s scope of practice and plan credentialing and contracting provisions.
Effective Date: April 1, 2018
Notes: Amended by R.I. SB 2540.

2017

Primary Focus: Parity – General
Title/Description: Coverage for treatment of mental health and substance use disorders
Citation: R.I. Gen. Laws § 27-38.2-1
Summary: Section (h) of Section 27-38.2-1 added the provision that patients with substance use disorders shall have access to evidence-based non-opioid treatment for pain, therefore coverage shall apply to medically necessary chiropractic care, and osteopathic manipulative treatment performed by a licensed individual.
Effective Date: September 27, 2017
Notes: Amended by R.I. HB 6124.

2016

H 7616/S 2536
Introduced: 3/2016
Sponsor: Reps. Serpa, Palangio, Fellela, Melo, McNamara and Sens. Miller, Nesselbush, Sosnowski, Archambault, Jabour
Status: Signed into law 7/2016
Summary: This is a comprehensive bill that aims to address the opioid crisis. Among other things, it amends a section of state insurance law about parity by extending the definition of medication assisted maintenance services to include buprenorphine, naltrexone, or other clinically appropriate medications, in addition to methadone.

H 5837/S 490
Introduced: 2/2016
Sponsor: Reps. Miller, Jabour, Crowley, Goodwin, Satchell
Status: Signed into law 6/2016
Summary: This is a comprehensive bill that aims to address the opioid crisis. Among other things, it amends a section of state insurance law about parity by extending the definition of medication assisted maintenance services to include buprenorphine, naltrexone, or other clinically appropriate medications, in addition to methadone.

2015

H 5900
Introduced: 3/2015
Sponsor: Rep. Gallison
Status: Signed into law 6/2015
Summary: Among many other things, this bill changed the state insurance law about autism coverage so that there is no longer an annual maximum in place for applied behavior analysis.

2014

H 8042/S 2801
Introduced: 3/2014
Sponsor: Reps. Serpa, Tomasso, Fellela, Ferri, Silva and Sens. Jabour, Miller, Satchell, Cool Rumsey, Pichardo
Status: Signed into law 6/2014
Summary: This bill changed the section of the state insurance law about parity by adding many subsections and changing some language. The specific, substantive changes as a result of this bill were:

The bill also added several other sections to the state insurance law that define certain types of care and treatment while also establishing standards for hospitals to follow when they discharge patients with substance use disorders.

H 7936/S 2359
Sponsor: Reps. Bennett, Hull, Handy, Silva, and Mattiello and Sens. Miller, Cool Rumsey, Ottiano, Sosnowski, and Goldin
Introduced: 2/2014
Status: Signed into law 6/2014
Summary: This bill added the section to the state health and safety law about utilization review that is relevant to parity. This section is summarized at the bottom of the page under “Rhode Island Parity Law.”

2013

H 6283/S 540
Introduced: 2/2013
Sponsor: Reps. Keable, Tanzi, Blazejewski, Silva and Sens. Miller, Ottiano, Goldin, Cool Rumsey, Nesselbush
Status: Signed into law 7/2013
Summary: Among many other things, this bill changed state law so that the Commissioner of Health Insurance is now required to monitor plans for compliance with the Federal Parity Law.

2012

H 7165/S 2560
Introduced: 1/2012
Sponsor: Reps. Palumbo, Morrison, Corvese, Naughton, Coderre and Sens. O`Neill, Perry, Gallo, Ottiano, Goodwin
Status: Signed into law 6/2012
Summary: This bill changed the section of the state insurance law about autism coverage to require coverage for psychiatry, psychology, and pharmaceutical services. The bill also changed some credentialing requirements for providers of applied behavioral analysis.

2011

H 5275/S 107
Introduced: 1/2011
Sponsor: Reps. Palumbo, Schadone, Menard, Petrarca, McCauley and Sens. O`Neill, Gallo, Metts, Perry, Paiva Weed
Status: Signed into law 6/2011
Summary: This bill added the section of the state insurance law about autism coverage, which is summarized at the bottom of this page under “Rhode Island Parity Law.” Bill H 7165/S 2560 from 2012 made very minor additions to this section (summarized above).

Rhode Island Parity Law

There is a section of Rhode Island’s state insurance law about parity for behavioral health coverage and another section about autism coverage. There is a subsection (subsection j) within the section of state law that requires the Health Insurance Commissioner to monitor plans for compliance with the Federal Parity Law. There is also a section of the state’s health and safety law that is relevant to parity for insurance plans’ utilization review programs.

Behavioral Health Coverage

This section of the state insurance law requires large employer fully-insured plans,small employer fully-insured plans, and individual plans to cover services for all behavioral health conditions that are in the DSM or ICD on the “same terms and conditions” as other medical services.

Financial requirements and quantitative treatment limitations for behavioral health services must be “no more restrictive” than those in place for other medical services.

If plans use non-quantitative treatment limitations for behavioral health services, they must be used similarly and “no more stringently” than those used for other medical services. Non-quantitative treatment limitations are defined as:

  • Medical management standards
  • Formulary design and protocols
  • Network tier design
  • Standards for provider admission to participate in a network
  • Reimbursement rates and methods for determining usual, customary, and reasonable charges
  • Other criteria that limit scope or duration of coverage for services in the treatment of mental health and substance use disorders, including restrictions based on geographic location, facility type, and provider specialty

Plans are required to cover medications for substance use disorders, specifically those used for opioid overdoses (like naloxone) and those used for chronic addiction (like methadone).

When conducting medical necessity reviews for behavioral health services, plans must do so in a way that is the same as how medical necessity reviews are conducted for other medical services.

Utilization Review

There is a section of the health and safety law that requires the Office of the Health Insurance Commissioner to develop reporting requirements for insurance plans’ utilization review programs for compliance with the Federal Parity Law and the Affordable Care Act.

This section also requires the Office of the Health Insurance Commissioner to make recommendations to the General Assembly as to how state laws and regulations could be changed to improve parity compliance for utilization review programs, or make these regulatory changes itself. Included among these recommendations or changes, this section of the law requires the Office of the Health Insurance Commissionerto describe the process by which the Office will investigate insurance plans for parity compliance in their utilization review programs.

Autism

This section of the law requires large employer fully-insured plans to cover autism services for children through age 14. Autism spectrum disorders are defined as “any of the pervasive developmental disorders” listed in the most recent version of the DSM.

“Coverage for physical therapy, speech therapy and occupational therapy and psychology, psychiatry and pharmaceutical services” for autism services must be similar to what is in place for treatment of other medical conditions.

There is a $32,000 annual maximum for applied behavior analysis.

Plans must cover out-of-network services outside of Rhode Island if it is determined these services are not available in-network.

Insurance plans are allowed to review a child’s treatment plan once every 3 months.

Deductibles,coinsurance, and general annual maximums for autism services must be similar to those used for other medical services.

Get Support

Rhode Island Insurance Division

Common Violations

In seeking care or services, be aware of the common ways parity rights can be violated.

Common Violations

Definition

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