230 R.I. Code R. 230-RICR-20-30-12.4

Current through December 3, 2024

Section 230-RICR-20-30-12.4 - Standards for Tobacco Cessation Programs

A. Every individual or group health insurance contract, plan or policy delivered, issued for delivery or renewed in this state that provides medical coverage that includes coverage for physician services in a physician's office or that provides major medical or similar comprehensive-type coverage shall include coverage for smoking cessation treatment, provided that if such medical coverage does not include prescription drug coverage, such contract, plan or policy shall not be required to include coverage for nicotine replacement therapy or any prescription drugs. Such medical coverage will, however, be required to provide outpatient counseling benefits for smoking cessation.

B. As used in this Part, smoking cessation treatment includes the tobacco dependence treatments identified as effective in the most recent clinical practice guideline published by the United States Department of Health and Human Services for treating tobacco use and dependence. (Fiore MC, Bailey WC, Cohen SJ, et al. Treating Tobacco Use and Dependence. A Clinical Practice Guideline. US Department of Health and Human Services. Public Health Service, 2008. Available at: http://www.surgeongeneral.gov/tobacco/treating_tobacco_use.pdf.)

C. Nicotine replacement therapy includes but is not limited to nicotine gum, patches, lozenges, nasal spray, and inhaler.

D. Health insurance contracts, plans, or policies to which this Part applies, may impose copayments and/or deductibles for smoking cessation treatment mandated by this section consistent with the contracts', plans' or policies' copayments and/or deductibles for physician services and medications. Nothing contained in this regulation shall impact the reimbursement, medical necessity or utilization review, managed care, or case management practices of these health insurance contracts, plans or policies.

E. This section shall not apply to insurance coverage providing benefits for:

1. Hospital confinement indemnity;

2. Disability income;

3. Accident only;

4. Long-term care;

5. Medicare supplement;

6. Limited benefit health;

7. Specified disease indemnity;

8. Sickness or bodily injury or death by accident or both; and

9. Other limited benefit policies.

230 R.I. Code R. 230-RICR-20-30-12.4