2026 -- H 7187 | |
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LC004118 | |
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STATE OF RHODE ISLAND | |
IN GENERAL ASSEMBLY | |
JANUARY SESSION, A.D. 2026 | |
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A N A C T | |
RELATING TO INSURANCE -- BENEFIT DETERMINATION AND UTILIZATION | |
REVIEW ACT | |
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Introduced By: Representatives Edwards, Bennett, Potter, Carson, Fogarty, and Casimiro | |
Date Introduced: January 21, 2026 | |
Referred To: House Health & Human Services | |
It is enacted by the General Assembly as follows: | |
1 | SECTION 1. Chapter 27-18.9 of the General Laws entitled "Benefit Determination and |
2 | Utilization Review Act" is hereby amended by adding thereto the following section: |
3 | 27-18.9-17. Utilization review decisions. |
4 | (a) A utilization review decision shall not retrospectively deny coverage for healthcare |
5 | services provided to a covered person, when prior approval has been obtained from the insurer or |
6 | its designee for those services, unless the approval was based upon fraudulent, materially |
7 | inaccurate, or misrepresented information submitted by the covered person, authorized person, or |
8 | the provider. |
9 | (b) For health benefit plans issued or renewed on or after January 1, 2027, an insurer shall |
10 | not require or conduct a prospective or concurrent review for a prescription medicine: |
11 | (1) That is used in the treatment of alcohol or opioid use disorder; |
12 | (2) That contains Methadone, Buprenorphine or Naltrexone; or |
13 | (3) That was approved before January 1, 2027, by the United States Food and Drug |
14 | Administration for the mitigation of opioid withdrawal symptoms. |
15 | (c) In conducting utilization reviews for Medicaid benefits, each Medicaid managed care |
16 | organization shall use the medical necessity criteria selected by the Rhode Island division of |
17 | insurance for making determinations of medical necessity and clinical appropriateness pursuant to |
18 | the utilization review plan. |
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1 | SECTION 2. This act shall take effect upon passage. |
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EXPLANATION | |
BY THE LEGISLATIVE COUNCIL | |
OF | |
A N A C T | |
RELATING TO INSURANCE -- BENEFIT DETERMINATION AND UTILIZATION | |
REVIEW ACT | |
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1 | This act would prohibit healthcare insurers from requiring or conducting a review for |
2 | prescription medicine that is used in the treatment of alcohol or opioid use disorder, that contains |
3 | Methadone, Burenorphine, or Naltrexone or that was approved for the mitigation of opioid |
4 | withdrawal symptoms, commencing January 1, 2027. |
5 | This act would take effect upon passage. |
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