H 7187

2026 -- H 7187
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 LC004118
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  STATE  OF  RHODE  ISLAND
  IN GENERAL ASSEMBLY
  JANUARY SESSION, A.D. 2026
  ____________
  AN ACT
  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:
1SECTION 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:
327-18.9-17. 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.
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  EXPLANATION
  BY THE LEGISLATIVE COUNCIL
  OF
  AN ACT
  RELATING TO INSURANCE -- BENEFIT DETERMINATION AND UTILIZATION
  REVIEW ACT
  ***
1This 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.
5This act would take effect upon passage.
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