Section 230-RICR-20-30-1.15 - Insurance Coverage for Serious Mental Illness1.15.1Statutory AuthorityThis addition of § 1.15 of this Part is promulgated pursuant to RI. Gen. Laws §§ 42-14-17 and 42-62-12 to implement R.I. Gen. Laws Chapter 27-38.2 ("Insurance Coverage for Serious Mental Illness" referred to herein as the "Act").
1.15.2DefinitionsA. Unless otherwise defined in the Act, for purposes of the Act and this § 1.15 of this Part, the following terms shall have the following meanings: 1. "Director" means the Director of the Department.2. "ERISA" means the Employee Retirement Income Security Act of 1974 (including but not limited to Section 514 thereof, 29 U.S.C. § 1144), as amended from time to time.3. "Health care insurers" shall have the meaning given to "Health insurers" in R.I. Gen. Laws § 27-38.2-2(a). 4. "Plan" means a health benefits plan as defined in R.I. Gen. Laws §42-62 - 4(d) provided, however, that the term does not include federal employee health benefit programs or services provided to self-insured employers subject to ERISA.5. "Serious Mental Illness" shall have the meaning given to "Serious Mental Illness" in R.I. Gen. Laws § 27-38.2-2(b).1.15.3Department's Jurisdiction -- Limits on ApplicabilityA. Certain Plans may: 1. be governed by contracts formed under laws of other states or of the United States and may, therefore, not be subject to the provisions of the Act or this § 1.15 of this Part; and2. not be subject to the Act or this § 1.15 of this Part because of the pre-exemption of all or a portion of the Act and this § 1.15 of this Part by ERISA.1.15.4Time Limitation of Coverage R.I. Gen. Laws § 27-38.2-4 requires that "inpatient coverage in cases where continuous hospitalization is medically necessary shall be limited to ninety (90) consecutive days." As used in the Act, the phrase "ninety (90) consecutive days" shall constitute a reference to a time limit per hospitalization of the patient, and not to a lifetime or annual time limit. 1.15.5Enforcement and PenaltiesThe Director shall have all of the enforcement powers granted or described in R.I. Gen. Laws §27-42-14 and this Part to enforce the provisions of the Act and this § 1.15 of this Part. The Director may consider as part of the exercise of such enforcement powers any information the Director deems relevant, including but not limited to, decisions, rulings or orders of any agency of the State of Rhode Island.
If any section, term or provision of this § 1.15 of this Part shall be adjudged invalid for any reason, that judgment shall not affect, impair, or invalidate any remaining section, term or provision, which shall remain in full force and effect.
230 R.I. Code R. 230-RICR-20-30-1.15