Provides that for treatment of mental health and substance use disorders, payors would rely upon criteria which reflect generally accepted standards of care when developing coverage.

Rhode Island Bill Summary: Mental Health & Substance Use Disorder Insurance Coverage

This bill would change the rules for how health insurance companies in Rhode Island decide what mental health and substance use disorder treatments they will cover. Specifically, it would require insurance companies (called "payors" in the bill) to use criteria that reflect generally accepted standards of care — meaning the treatment approaches that the broader medical and mental health community recognizes as effective and appropriate — when determining coverage for these conditions. The goal is to ensure that insurance coverage decisions are based on established medical science rather than criteria developed primarily to limit costs or restrict access to care.

This bill would affect anyone in Rhode Island who has health insurance and needs treatment for mental health conditions (such as depression, anxiety, or bipolar disorder) or substance use disorders (such as addiction to alcohol or drugs). Currently, insurance companies may use their own internal guidelines to decide whether to approve or deny treatment, and those guidelines don't always align with what doctors and mental health professionals consider best practice. Under this bill, those coverage decisions would need to be grounded in widely recognized medical standards.

The bill has been introduced in the House and referred to the House Health & Human Services Committee, which has scheduled it for a hearing but has also recommended it be held for further study, meaning it is still in the early stages of the legislative process and has not yet been passed into law.