Shown verbatim: the complete text as captured from the official PDF posted by the Rhode Island General Assembly, fetched 2026-07-29. Page and line markers are part of the official record; nothing is edited or removed. The official bill page.
H7187 2026 -- H 7187 ======== LC004118 ======== STATE OF RHODE ISLAND IN GENERAL ASSEMBLY JANUARY SESSION, A.D. 2026 ____________ A N A C T RELATING TO INSURANCE -- BENEFIT DETERMINATION AND UTILIZATION REVIEW ACT 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. 1 SECTION 2. This act shall take effect upon passage. ======== LC004118 ======== LC004118 - Page 2 of 3 EXPLANATION BY THE LEGISLATIVE COUNCIL OF A N A C T RELATING TO INSURANCE -- BENEFIT DETERMINATION AND UTILIZATION REVIEW ACT *** 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. ======== LC004118 ======== LC004118 - Page 3 of 3
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