2026 -- H 7862

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LC005437

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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 -- HEALTHCARE ACCESSIBILITY AND QUALITY

ASSURANCE ACT

     Introduced By: Representative Mia A. Ackerman

     Date Introduced: February 27, 2026

     Referred To: House Corporations

     (by request)

It is enacted by the General Assembly as follows:

     SECTION 1. Chapter 27-18.8 of the General Laws entitled "Healthcare Accessibility and

Quality Assurance Act" is hereby amended by adding thereto the following section:

     27-18.8-3.1. Unilateral modification of provider contracts prohibited.

     (a) No healthcare entity, as defined in § 27-18.8-2, including any affiliate, subsidiary, or

contracted vendor acting on behalf of the healthcare entity, that offers, issues, or renews a health

plan in this state, shall unilaterally modify, amend, or reinterpret any material term or condition of

a contract with a healthcare provider, during the term of such contract.

     (b) For purposes of this section, a "material term or condition" means and includes, but is

not limited to, changes to reimbursement methodologies or underlying fee schedules; payment

terms; carrier policies, protocols, or procedures; definitions of covered services or covered sites of

service; utilization review requirements, prior authorization requirements, or medical necessity

criteria; quality management or quality improvement requirements; credentialing requirements;

billing or documentation requirements; clinical policy bulletins or coverage determination or

covered preventive health services.

     (c) Material terms and conditions shall include any policy, protocol, fee schedule, provider

manual, or guidance incorporated by reference into the contract, whether issued electronically or

otherwise.

     (d) A healthcare entity may implement changes to a health carrier contract only:

     (1) Upon the mutual written agreement of the healthcare entity and the healthcare provider;

or

     (2) Where such change is expressly required by state or federal law.

     (e) Any change not required by law shall not take effect until the renewal of the contract

term and then only if the healthcare entity has provided written notice of the proposed change at

least ninety (90) days before the renewal.

     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 -- HEALTHCARE ACCESSIBILITY AND QUALITY

ASSURANCE ACT

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     This act would prohibit a healthcare entity from unilaterally modifying amending or

reinterpreting any material term or condition of a contact with a healthcare provider during the term

of such contact.

     This act would take effect upon passage.

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LC005437

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