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RI H7187
Bill
Status
1/21/2026
Primary Sponsor
John Edwards
Click for details
AI Summary
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Prohibits insurers from retrospectively denying coverage for healthcare services that received prior approval, unless the approval was based on fraudulent or materially inaccurate information
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Eliminates prior authorization and concurrent review requirements for prescription medications treating alcohol or opioid use disorder, effective for plans issued or renewed on or after January 1, 2027
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Specifically exempts medications containing Methadone, Buprenorphine, or Naltrexone from utilization review requirements
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Exempts FDA-approved medications for mitigating opioid withdrawal symptoms (approved before January 1, 2027) from prospective or concurrent review
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Requires Medicaid managed care organizations to use medical necessity criteria selected by the Rhode Island Division of Insurance when conducting utilization reviews
Legislative Description
Prohibits healthcare insurers from requiring or conducting a review for prescription medicine used to treat alcohol or opioid use disorder containing Methadone, Burenorphine, or Naltrexone, or approved to mitigate opioid withdrawal symptoms.
Insurance
Last Action
Committee recommended measure be held for further study
2/3/2026