Rhode Island Behavioral Health Care Reform Act of 2014
Background

The Joint Commission has taken on the task of improving the value of mental health
services in RI
o successful improvement requires addressing the specific challenges facing
behavioral health

Behavioral health funding has recently been cut significantly
o however, better management of available resources is needed before increased (or
restored) funding is justified

Health care reform is driving funding toward incentives for quality rather than volume
o there is national recognition of the central role behavioral health must play if
health care reform goals are to be achieved
o nonetheless, behavioral health is almost completely left out of reform efforts

This bill thus requests no additional funding, but requires significantly improved
management of behavioral health spending and service quality
Strategy: This bill would ensure that

behavioral health is included in existing health care law wherever relevant (to ensure the
legislature’s intent to regulate behavioral health is as apparent as for other health care)

available health care funding is actively managed to best address mental health and
health-related behavior (e.g., obesity, smoking)

behavioral health funding levels would be justified by population health priorities and
health care reform goals including affordability
Result: This bill would

improve affordability and effectiveness of all health care

implement mental health parity more completely

ensure that behavioral health is managed to the same standards as all health care


act on national priorities that are widely recognized but not addressed
serve as a model that returns Rhode Island to our standing as national leaders in
behavioral health care policy and management
42-14.7-2 Legislative findings: The general assembly finds and declares that:
(1) Mental health and substance abuse problems affect one out of every four Rhode
Islanders every year.
(2) Health-related behaviors such as diet, exercise, tobacco use, and compliance with
medical treatment affect even more Rhode Islanders every year.
(3) The resulting costs, both financial and in impairment, loss of productivity and
suffering, cause significant burden on the state and its citizens.
(4) Health care reform efforts can only succeed if a comprehensive approach is taken that
includes the role of behavior and behavioral health in health and healthcare.
(5) Despite its significant potential impact on health care cost and effectiveness, spending
on behavioral health is a small percentage of all health care spending and is thus often neglected
in health care reform, improvement, or cost-containment efforts.
(6) As is true for citizens of all states, half of Rhode Islanders with mental health,
substance abuse, or health-related behavioral problems receive no treatment at all, and of those
who do receive treatment, a large majority receive treatment that does not meet national
guidelines for effectiveness, resulting in significant avoidable personal suffering and waste of
health care funds.
(7) Stigma, as defined by the US Surgeon General to include lack of understanding and
lack of proportional attention to behavioral health, impedes effective management of behavioral
health and other healthcare resources to address health-related behaviors and behavioral health
cost-effectively.
(8) Tragedies such as the shootings in Newtown, CT, have heightened attention to the
need for better regulation, management and delivery of behavioral health services.
(9) Therefore, it is in the best interest of the state to ensure the most appropriate use of
healthcare resources to more effectively manage behavioral health services to protect the welfare
of its citizens.
CHAPTER 42-14.7
The Rhode Island Behavioral Health Care Reform Act of 2013 –
42-14.7-3 Purpose: The purpose of the behavioral health reform act of 2013 is to ensure
appropriate use of healthcare resources to manage the contribution of behavioral health and
behavioral health services to the affordability and effectiveness of healthcare.
1. Changes are made to
Title 23, Chapter 1, “Department of Health”,
Title 23, Chapter 14.1, "Health Professional Loan Repayment Program”,
Title 23, Chapter 17.12, “Health Care Services – Utilization Review Act”,
Title 23, Chapter 17.13, "Health Care Accessibility and Quality Assurance Act",
Title 23, Chapter 17.17, "Health Care Quality Program",
Title 23, Chapter 17.22, "Healthy Rhode Island Reform Act of 2008",
Title 27, Chapter 18, "Accident and Sickness Insurance Policies",
Title 27, Chapter 18.5, "Individual Health Insurance Coverage",
Title 27, Chapter 18.6, "Large Group Health Insurance Coverage",
Title 27, Chapter 19, "Nonprofit Hospital Service Corporations",
Title 27, Chapter 20, "Nonprofit Medical Service Corporations",
Title 27, Chapter 20.9, "Contract with Health Care Providers",
Title 27, Chapter 38.2, "Insurance Coverage for Mental Illness and Substance Abuse",
Title 27, Chapter 41, "Health Maintenance Organizations",
Title 27, Chapter 50, "Small Employer Health Insurance Availability Act",
Title 27, Chapter 74, "Discount Medical Plan Organization Act",
Title 42, Chapter 14.5, "The Rhode Island Health Care Reform Act of 2004 – Health Insurance
Oversight”
Title 42, Chapter 14.6, "Rhode Island All-Payer Patient-Centered Medical Home Act"
2. Most changes add “behavior”, “behavioral health” or “mental health”, “behavioral health
providers”, or “health-related behavior” where relevant, applying current health care
oversight laws to behavioral health but not otherwise changing their purpose, meaning, or
effects
3. Title 23, Chapter 1, “Department of Health” is amended to
a. add behavioral health screening or prevention services recommended for children by
the United States Preventive Services Task Force (USPSTF) for routine childhood
screening and prevention to the existing immunization program;
b. regulate routine childhood behavioral health screenings, diagnostic and treatment
services; and
c. convene an advisory committee to make recommendations regarding service cost and
feasibility for any USPSTF recommendations for behavioral health screening or
prevention services for adults.
4. Title 23, Chapter 17.12, “Health Care Services – Utilization Review Act”, is amended that:
a. The Director of Health will certify the material equivalence of criteria and review
procedures for behavioral health services with those applied to primary care services
5. Title 23, Chapter 17.13, “Health Care Accessibility and Quality Assurance Act”, is amended:
a. to include behavioral health in Network adequacy standards required by the Patient
Protection and Affordable Care Act;
b. that incentives be offered for behavioral health services to be provided on-site in
primary care practices; and
c. that incentives be offered for behavioral health services that successfully reduce use
of hospital levels of care
6. Title 23, Chapter 17.22, "Healthy Rhode Island Reform Act of 2008", is amended to add
expectations and incentives for behavioral health professionals to improve the costeffectiveness of their services
7. Title 27, Chapter 19, “Nonprofit Hospital Service Corporations”, Chapter 20, “Nonprofit
Medical Service Corporations”, Chapter 41, "Health Maintenance Organizations", and
Chapter 50, "Small Employer Health Insurance Availability Act", are amended to require
copayments for behavioral health office visits to be equivalent to those for primary care
office visits.
8. Title 27, Chapter 20.9, “Contract with Health Care Providers”, is amended that pay-forperformance quality improvement programs offered to primary care physicians or their
equivalent will be made available for behavioral health providers.
9. Title 27, Chapter 38.2, "Insurance Coverage for Mental Illness and Substance Abuse", is
amended to:
a. include behaviors that affect medical illnesses and diseases in the regulation of
mental illness and mental health services
b. use illnesses and diseases commonly treated by primary care providers as the standard
for parity of mental illness coverage
c. revise visit limits for mental health and substance abuse services to be managed by
medical necessity rather than a pre-determined number, as intended by the Patient
Protection and Affordable Care Act
10. Title 27, Chapter 50, “Small Employer Health Insurance Availability Act”, is amended to
include a focus on behavioral health care and management of health-related behavior in the
management of the chronically ill population
11. Title 42, Chapter 14.5, “The Rhode Island Health Care Reform Act of 2004 – Health
Insurance Oversight”, is amended to include behavioral health conditions, services, and
providers in the Health Insurance Commissioner’s protection of the interests of consumers,
encouragement of fair treatment of providers, efforts to improve the efficiency and quality of
health care delivery and affordability of health care
12. Title 42, Chapter 14.6, “Rhode Island All-Payer Patient-Centered Medical Home Act” is
amended to encourage consideration of reforms that would promote inclusion of behavioral
health in patient-centered medical homes