Senate OKs Miller bill to help prevent rehab insurance gap
STATE HOUSE – The Senate today approved legislation to improve support for those hospitalized for drug overdoses and mental health emergencies by ensuring uninterrupted insurance coverage of clinically appropriate residential or inpatient treatment after emergency treatment.
The legislation (2019-S 0307A), sponsored by Senate Health and Human Services Committee Chairman Joshua Miller (D-Dist. 28, Cranston, Providence), would ensure that when a qualified medical or clinical professional determines that residential or inpatient care, including detoxification and stabilization services, is the most appropriate and least restrictive level of care necessary, a patient would have presumptive coverage for those services during their insurance’s review of the request.
That presumptive coverage would prevent a patient from having to leave a hospital, clinic or other facility where they’ve received emergency treatment and wait — possibly for days — before they can access the residential or inpatient treatment they need.
“Sending patients home and making them wait for approval to be admitted to rehab, a detox facility or other residential treatment creates an obstacle between them and the program that will help address their condition. They’re less likely to actually go if they have to wait a day or longer, and more likely to relapse into the same problem that created the emergency situation,” said Chairman Miller. “Getting them straight to treatment is more effective, will help prevent rehospitalization and in those ways, will ultimately save on medical costs, too.”
The legislation provides that the health professional making the recommendation would have 24 hours from the patient’s admission, or until at least 24 hours before the expiration of a previous authorization, to submit the patient’s treatment plan to the insurer. It applies only to the insurance’s in-network services.
The bill, which would take effect Jan, 1, also requires that each hospital and free-standing emergency care facility incorporate patient consent for certified peer recovery specialist services into its comprehensive patient consent form.
Under the bill, the General Assembly would hold a hearing to review its requirements, including presentations from payors, providers and other stakeholders, by March 1, 2022.
The bill, which now goes to the House of Representatives, is cosponsored by Sen. Gayle L. Goldin (D-Dist. 3, Providence), Sen. Adam J. Satchell (D-Dist. 9, West Warwick), Sen. James C. Sheehan (D-Dist. 36, North Kingstown, Narragansett) and Sen. Bridget G. Valverde (D-Dist. 35, North Kingstown, East Greenwich, Narragansett, South Kingstown).
For more information, contact:
Meredyth R. Whitty, Publicist
State House Room 20
Providence, RI 02903