RI H7862

Healthcare entities offering health plans in Rhode Island are prohibited from unilaterally modifying, amending, or reinterpreting any material term or condition of contracts with healthcare providers during the contract term.

Material terms include reimbursement methodologies, fee schedules, payment terms, prior authorization requirements, medical necessity criteria, credentialing requirements, billing requirements, and clinical policy bulletins.

Policies, protocols, fee schedules, and provider manuals incorporated by reference into contracts are also covered by the prohibition.

Contract changes may only be implemented through mutual written agreement between the healthcare entity and provider, or when expressly required by state or federal law.

Non-legally-required changes take effect only at contract renewal with at least 90 days written notice to the provider.