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House Passes AG Kilmartin Legislation That Expands Insurance Coverage for Substance Abuse Treatment

Rhode Island House of Representatives today passed legislation filed at the request of Attorney General Peter F. Kilmartin that provides greater access to residential substance abuse treatment. The legislation provides that health insurers may not deny continued residential or inpatient treatment coverage if the subscriber is currently in residential or inpatient services for a mental health and/or substance abuse disorder and the provider of treatment has recommended continued residential or inpatient treatment.

The legislation (H7625), sponsored by Representative Patricia A. Serpa (D., District 27 Coventry, Warwick, West Warwick), now heads to the senate for consideration. Companion legislation (S2510) is sponsored by Senator Elizabeth A. Crowley (D., District 16 Central Falls, Pawtucket).

"Unfortunately, Rhode Island has been in the eye of the storm of heroin and fentanyl overdoses. While the State has made great strides in providing access to naloxone, increasing recovery coaches in our emergency rooms, and prosecuting drug traffickers, I believe that we are overlooking essential pieces to this complex problem," said Attorney General Kilmartin. "It is my sincere belief that to address the substance abuse and overdose epidemic that is shattering the lives of families across our State, we must honestly face the truth that not enough is being done to provide the necessary services and treatment for those suffering from this disease."

"As long as the prescriber or doctor is making diagnosis recommendations that are consistent with the standards of the American Society of Addiction Medicine, we should not be releasing patients back in to society before they are ready," said Representative Serpa. "Years of mental or societal instability cannot be undone in a two-week hospital stay. We end up spending more money by releasing these individuals back to society before they are ready. They are often re-admitted for worse or more serious offenses. Getting it right after the first round of treatment increases that person's chances of becoming a citizen who can function in and work in society."

Rhode Island, on some level, has recognized mental health and substance abuse disorder parity since 1994. However, Attorney General Kilmartin believes the State needs to make sure that parity is justly acknowledged by insurance providers. It is well known in this State, and across the country, that one of the biggest barriers to recovery is access to necessary treatment. In fact, many have suffered relapses because they were released from inpatient treatment too soon. This is most disturbing for those suffering from heroin and prescription opiate use disorders as this when they are most vulnerable to overdose.

In fact, the National Institute of Drug Abuse's Principles of Drug Addiction Treatment states:

"Remaining in treatment for an adequate period of time is critical. The appropriate duration for an individual depends on the type and degree of the patient's problems and needs. Research indicates that most addicted individuals need at least 3 months in treatment to significantly reduce or stop their drug use and that the best outcomes occur with longer durations of treatment. Recovery from drug addiction is a long-term process and frequently requires multiple episodes of treatment. As with other chronic illnesses, relapses to drug abuse can occur and should signal a need for treatment to be reinstated or adjusted. Because individuals often leave treatment prematurely, programs should include strategies to engage and keep patients in treatment."

"My office has experienced this firsthand in the criminal justice system. As individuals are placed into inpatient treatment, they are often too quickly released from this necessary treatment as the insurance provider has refused to cover, or continue to cover, the cost of this crucial and potentially lifesaving care," added Kilmartin. "For those individuals, the Court can order the individual into treatment, thus forcing the insurance company to cover such treatment. But this begs the question: what happens to those individuals who are not part of the criminal justice system? Who fights for them to make sure their treatment is covered? Why are two portions of our population being treated disproportionally when suffering from the same disease?"

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