2026 -- S 2109 | |
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LC003217 | |
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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: Senators Urso, DiMario, Kallman, Murray, Acosta, Rogers, Gu, and | |
Date Introduced: January 16, 2026 | |
Referred To: Senate 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 for the treatment of alcohol or substance use |
4 | disorder. |
5 | (a) For health benefit plans issued or renewed on or after the effective date of this section, |
6 | an insurer or pharmacy benefit manager shall not require or conduct a prospective or concurrent |
7 | review for a prescription medicine: |
8 | (1) That is used in the treatment of alcohol or opioid use disorder and contains methadone, |
9 | buprenorphine or naltrexone; or |
10 | (2) That is used in the treatment of alcohol or opioid use disorder and has been approved |
11 | by the United States Food and Drug Administration for the management of alcohol or opioid use |
12 | disorder, or the mitigation of opioid withdrawal symptoms. |
13 | SECTION 2. Chapter 40-8 of the General Laws entitled "Medical Assistance" is hereby |
14 | amended by adding thereto the following section: |
15 | 40-8-33. Utilization reviews for Medicaid benefits. |
16 | In conducting utilization reviews for Medicaid benefits, each Medicaid managed care |
17 | organization shall use the medical necessity criteria selected by the executive office of health and |
18 | human services for making determinations of medical necessity and clinical appropriateness |
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1 | pursuant to the utilization review plan. |
2 | SECTION 3. 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 or pharmacy benefit managers from requiring |
2 | or conducting a review for prescription medicine that is used in the treatment of alcohol or opioid |
3 | use disorder, that contains methadone, burenorphine, or naltrexone or that was approved for the |
4 | mitigation of opioid withdrawal symptoms. |
5 | This act would take effect upon passage. |
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