Action in the Regulatory Arena
|Primary Focus||Parity: General|
|Agency||Executive Office of Health and Human Services|
|Title/Description||Medicaid Managed Care Delivery Options|
|Citation||210 RICR 030-05-2|
Explanation of Rite Care which is a managed care delivery system to increase access to primary and preventative care for certain individuals and families who otherwise might not be able to afford or obtain affordable coverage. The rule is consistent with the federal managed care rules, certain mental health parity requirements added to the Public Health Service Act by the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008. The rule prohibits Rite Care from applying treatment limitations on mental health and substance use disorders that would be more restrictive than those applied to medical/surgical benefits. Rite Care MCOs must maintain provider networks in locations that are geographically accessible to the populations to be served, comprised of hospitals, physicians, advanced practice practitioners, mental health providers, substance use disorder providers, pharmacies, transportation services, dentists, school based health centers, etc. in sufficient numbers to make available all services in a timely manner. Rite Care MCOs must make services available within twenty-four (24) hours and seven (7) days per week, including services for mental health and substance use disorders for treatment of an urgent medical problem. The MCOs must make services available within thirty (30) days for treatment of a non-emergent, non- urgent medical problem. This thirty (30) day standard does not apply to appointments for routine physical examinations, nor for regularly scheduled visits to monitor a chronic medical condition if the schedule calls for visits less frequently than once every thirty (30) days. Non- emergent, non-urgent mental health or substance use appointments for diagnosis and treatment must be made available within ten (10) days.
|Effective Date||1/8/2018 (a technical revision made effective date 6/29/2018)|
Inactive Rule 210-7571 led to 210 RICR 030-05-02, was promulgated to reformat, consolidate, and amend the existing regulations in the Medicaid Code of Administrative Rules as follows: #0350, “RIte Smiles”; #1309, “RIte Care Program”; #1310 “Rhody Health Program”; #1311 “Enrollment”; and #1314 “Communities of Care” and replace these five rules with one newly amended rule. This one rule will supersede ERLIDs # 8365; 8366; 7807; 7575; 6935.
OHIC held a meeting of the Health Insurance Advisory Council. The meeting minutes (pdf | Get Adobe® Reader®) reveal that OHIC suspended their mental health parity market conduct exams because of budget cuts. However, OHIC applied for the Health Insurance Enforcement and Consumer Protections Grant, (pdf | Get Adobe® Reader®) which would allow the Office to hire additional staff and resume the exams.
OHIC held a meeting of the Health Insurance Advisory Council. The meeting minutes (pdf | Get Adobe® Reader®) reveal that the council discussed many topics, including current efforts targeting mental health parity. Unfortunately because of the end of federal grants and no increased appropriation during the state budget process, Health Commissioner Hittner stated that they will have to discontinue their mental health parity work.
OHIC released a press release to bring awareness to S2510/H7625. The senate bill was filed at the request of Attorney General Peter F. Kilmartin and would require plans to cover at least 90 days of residential or inpatient services for mental health and substance use disorders. This bill passed the house but died in the senate in 6/2016.
After receiving complaints from consumers that insurance plans were not covering needed behavioral health services, the Office of the Health Insurance Commissioner (OHIC) has initiated market conduct examinations on four insurers to see if they are violating parity laws. The meeting minutes (pdf | Get Adobe® Reader®) from a meeting of the Governor’s Council on Behavioral Health in January, 2016 provides a summary of these exams on pg. 2-3.The OHIC sent letters to all insurers in the state that they must submit any information requested as part of the market conduct examinations.
- 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
The Rhode Island Office of the Health Insurance Commissioner (OHIC) requires small employer fully-insured plans and individual plans to complete this checklist (pdf | Get Adobe® Reader®) each year (this particular link is from 2014). On page 13 plans must certify that they comply with the Federal Parity Law, the final regulation (pdf | Get Adobe® Reader®) of the Federal Parity Law, and the section of the state law about parity (section of state law summarized below under “Rhode Island Parity Law”). The checklist asks plans to:
“…describe, through illustrations, FAQ’s, or other consumer explanation how the Plan provides for Parity in connection with financial requirements, quantitative treatment limitations, prescription drug benefits, and non-quantitative treatment limitations. ”