2026 -- S 2109 AS AMENDED

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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

     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:

     SECTION 1. Chapter 27-18.9 of the General Laws entitled "Benefit Determination and

Utilization Review Act" is hereby amended by adding thereto the following section:

     27-18.9-17. Utilization review decisions for the treatment of alcohol or substance use

disorder.

     (a) A utilization review decision shall not retrospectively deny coverage for healthcare

service provided to a covered person, when prior approval has been obtained from the insurer or its

designee for those services, unless the approval was based upon fraudulent, materially inaccurate,

or misrepresented information submitted by the covered person, authorized person, or the provider.

     (b) For health benefit plans issued or renewed on or after January 1, 2027, an insurer or

shall not require or conduct a prospective or concurrent review for a prescription medicine:

     (1) That is used for the treatment of alcohol or opioid use disorder; (2) That contains

methadone, buprenorphine or naltrexone; or

     (3) That was approved before January 1, 2027, by the United States Food and Drug

Administration for the management of alcohol or opioid use disorder, or the mitigation of opioid

withdrawal symptoms.

     SECTION 2. Chapter 40-8 of the General Laws entitled "Medical Assistance" is hereby

amended by adding thereto the following section:

     40-8-33. Utilization reviews for Medicaid benefits.

     In conducting utilization reviews for Medicaid benefits, each Medicaid managed care

organization shall use the medical necessity criteria selected by the executive office of health and

human services for making determinations of medical necessity and clinical appropriateness

pursuant to the utilization review plan.

     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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     This act would prohibit healthcare insurers or pharmacy benefit managers from requiring

or conducting a review for prescription medicine that is used in the treatment of alcohol or opioid

use disorder, that contains methadone, burenorphine, or naltrexone or that was approved for the

mitigation of opioid withdrawal symptoms.

     This act would take effect upon passage.

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