Bill > S2564

This bill requires that insurance providers, when determining coverage for mental health and substance use disorder treatments, must use criteria that align with "generally accepted standards of care," which are defined as practices and guidelines recognized by healthcare professionals in relevant fields like psychiatry and addiction medicine, as found in sources such as patient placement criteria and clinical practice guidelines from nonprofit professional associations. It also mandates that providers cannot alter their clinical criteria to reduce coverage for mental health treatment below these established standards and must use specific, age-appropriate patient placement criteria developed by nonprofit professional provider associations for utilization review, ensuring that coverage decisions for service intensity or level of care are consistent with these criteria, and any denial of care must clearly explain the payor's assessment against these standards. The bill also clarifies that medication-assisted treatment for substance use disorders is covered and that cost-sharing for behavioral health and medication maintenance visits should be consistent with primary care visits, regardless of provider license, as long as the care is within the provider's scope of practice and the plan's credentialing.

Health and Social Services

https://status.rilegislature.gov/