Amends the provisions for insurance coverage of mental health, mental illness, and substance use disorders.
Summary
H6061 amends Rhode Island’s insurance parity law for mental health and substance use disorder treatment. It requires group and individual health plans to cover these services on the same terms and conditions as other medical care, without annual or lifetime dollar limits, and with financial requirements and treatment limits no more restrictive than those applied to comparable medical/surgical benefits. The bill also specifies the benefit classifications used for parity analysis, includes medication-assisted treatment for substance use disorders, and directs payors to use recognized clinical criteria for determining levels of care.
The bill further tightens standards for how insurers develop and apply clinical criteria. For substance use disorder treatment, payors must rely on American Society of Addiction Medicine criteria; for mental health treatment, they must rely on generally accepted standards of care and may not modify those criteria to reduce coverage below that level. It also requires parity in cost-sharing for behavioral health counseling and medication maintenance visits when compared with primary care office visits, and it adds a definition of “generally accepted standards of care” and related terms to the statute.
Impact
If enacted, the bill would amend chapter 27-38.2 of the Rhode Island General Laws governing insurance coverage for mental illness and substance use disorders. It would expand and clarify insurer obligations regarding parity, clinical criteria, medication-assisted treatment, and cost-sharing, affecting health insurers, group health plans, and individual market plans. The bill would also make explicit that certain non-opioid pain treatments, including medically necessary chiropractic care and osteopathic manipulative treatment, are covered for patients with substance use disorders when appropriate.
Sentiment
The available record shows no committee transcript, recorded vote, or formal opposition, so there is no documented debate to gauge support or resistance. Based on the bill’s structure and purpose, it appears to be framed as a patient-protection and coverage-expansion measure aimed at strengthening mental health and addiction treatment access. The sponsor list suggests broad legislative interest in behavioral health parity.
Contention
The main policy issues likely to draw scrutiny are the bill’s limits on insurer discretion in setting clinical criteria, its requirement to use specific standards such as ASAM and other generally accepted care guidelines, and its parity rules for cost-sharing and treatment limitations. Insurers and payors could view these provisions as restricting utilization management and increasing coverage obligations, while advocates for behavioral health access would likely support them as necessary to prevent undercoverage of mental health and substance use disorder treatment.
Residential Substance Use Disorder Treatment Act of 2023 This bill revises and reauthorizes through FY2027 grants for residential substance use disorder treatment programs at state and local correctional and detention facilities. Among the revisions, the bill replaces statutory references to substance abuse with substance use disorder, specifies that the term residential substance use disorder treatment program includes a medication-assisted treatment program, requires the chief medical officer or other staff overseeing a program to complete training on the science of addiction and the latest research and clinical guidance on treating substance use disorders in criminal justice settings, and allows people who are awaiting trial or in pretrial detention to participate in the programs.
Requiring licensure of outpatient substance use disorder treatment facilities and relative to complaint investigation of treatment facilities by the department of health and human services office of the ombudsman and making an appropriation therefor.
Establishing the Nonnarcotic Medication Substance Use Disorder Treatment Program; in organization and jurisdiction of courts of common pleas, providing for court assessments for substance use disorder treatment; in other criminal provisions, further providing for supervisory relationship to offenders; and, in Pennsylvania Board of Probation and Parole, further providing for supervisory relationship to offenders.