RI S3089

Healthcare entities (insurers) and their affiliates are prohibited from unilaterally modifying, amending, or reinterpreting material terms of contracts with healthcare providers during the contract term.

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

Policies, provider manuals, and guidance documents incorporated by reference into contracts are also protected from mid-contract changes.

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

Non-legally-required changes may only take effect at contract renewal, with at least 90 days written notice before the renewal date.