Sen. Ujifusa, Rep. Tanzi introduce bills to help patients with mental health and substance use disorders
“Despite a 2008 federal law that requires insurance coverage for mental health conditions, including substance use disorders, to be no more restrictive than insurance coverage for other medical conditions, insurers can routinely deny critical mental health treatment based on their own rules, which are designed to minimize patients’ use of care,” said Representative Tanzi (D-Dist. 34, South Kingstown, Narragansett).
“If you wake up from a diabetic
coma, your insurance will cover continuing care for your diabetes. But a person
can be hospitalized for an overdose and be denied coverage for continuing
substance dependency treatment. Both cases are life-threatening health issues
that warrant care, but they are not always treated equally by insurers.”
Says Senator Ujifusa (D-Dist. 11, Portsmouth, Bristol), “About 21% of people 18 and older have a mental illness and only 46% of them get mental health care; about 14.5% of people 12 and older have a substance use disorder and only 6.5% of them get care. Clearly, we have a mental health care crisis that we either address today, or will cause us more serious harms and costly solutions later.”
The first bill (2025-S 0193, 2025-H 6061) requires insurers to use
generally accepted standards of care when making decisions about whether to pay
for behavioral health treatment.
Explains Mental Health Association of RI (MHARI) Executive
Director Laurie-Marie Pisciotta, “Many insurers develop their own ‘medical
necessity’ guidelines, which can vary greatly from plan to plan, and need not
align with what providers believe is in the best interest of their patients.
This can result in behavioral health problems, such as depression or anorexia,
too often being viewed as acute problems that do not require longer-term care.”
In Rhode Island, the bill is supported by MHARI, RIPIN,
Newport Mental Health, Protect Our Healthcare RI, Rhode Island Medical Society,
Lifespan, Rhode Island Psychological Association, the Economic Progress
Institute, and behavioral health care providers. This legislation is part of
model legislation that was developed by The Kennedy Forum in partnership with
the American Psychiatric Association, the American Psychological Association,
NAMI, Mental Health America, the National Council for Behavioral Health, and
more than 30 additional national organizations. So far, four states have
adopted the model legislation in full – California, Illinois, Georgia, and
Oregon.
The second bill 2025-S 0054/ 2025-H 5432 would prevent insurers from requiring that
patients obtain prior authorization before seeking in-network mental health or
substance use disorder health care.
Blue Cross Blue Shield of Rhode Island (BCBSRI) proactively
dropped its preauthorization for such services in 2018, in response to OHIC
efforts to enforce parity requirements, and the sponsors introduced the bill to
require other insurers to follow suit.
“BCBSRI has had this policy for years and likely saved money
because it was not blocking early access to behavioral health care,” said
Representative Tanzi. “There is no evidence that other insurance companies
would face hardships in complying, and this bill is widely supported by the
Office of the Health Insurance Commissioner, the Department of Behavioral
Health and Developmental Disabilities and Hospitals, as well as MHARI, RIPIN,
Lifespan, Newport Mental Health and behavioral healthcare providers.”
Senator Ujifusa and Representative Tanzi urge patients and
advocates to submit testimony by email with the subject line “In support of
2025-S 0193/2025-H 6061 and 2025-S 0054/2025-H 5432.” Written testimony should
describe why the writer supports the bills, including challenges caused by lack
of parity and prior authorization requirements. Send testimony to the Senate
HHS Committee to SLegislation@rilegislature.gov and to the House HHS
Committee to HouseHealthandHumanServices@rilegislature.gov.
