RI 2026 H7348: Insurance - Accident and Sickness Insurance Policies

Plain-English Summary

This legislation mandates "single site parity" for health insurance reimbursements in Rhode Island. It requires that all health insurance carriers, including non-profit hospital service corporations and HMOs, pay independent healthcare facilities the same reimbursement rates as hospital-affiliated facilities for providing identical healthcare services. The goal is to ensure that a medical procedure costs the same to the insurer regardless of whether it is performed at a large hospital system or a private independent practice. The Health Insurance Commissioner is tasked with creating regulations to enforce this requirement.

For younger readers

Imagine you and a friend both have lemonade stands. You sell a cup of lemonade for one dollar. Your friend, who belongs to a big club, sells the exact same lemonade but gets paid two dollars for it just because they are in the club. This bill changes the rules for doctors. It says that insurance companies must pay independent doctors the same amount of money that they pay doctors who work for big hospitals, as long as they are doing the exact same job. It makes sure everyone gets paid fairly for the same work.

Who & Where It Applies

Impacted groups

Independent healthcare providersHospital-affiliated facilitiesHealth insurance companiesPatientsHealth Insurance Commissioner

Impacted communities

All

Constitutional & Fiscal Check

None Likely

Estimated cost

None

Estimated revenue

None

Bill Analysis

Both viewpoints

For Progressives

Strengthens the viability of independent community health clinics, helping to prevent large corporate hospital systems from monopolizing local healthcare markets and dictating prices.
Promotes equity in the healthcare economy by ensuring that compensation is based on the actual service provided rather than the corporate size or market power of the provider.
May increase access to care in underserved communities by ensuring that small, local medical offices receive sufficient funding to remain open and operational.
Could financially destabilize non-profit safety-net hospitals that rely on higher commercial reimbursement rates to cross-subsidize care for the poor and uninsured.
Risks increasing overall health insurance premiums for working families if insurers raise the rates for independent providers to match hospitals rather than lowering hospital rates.
Fails to address the fundamental systemic issues of a for-profit insurance model, offering a market-based adjustment rather than the comprehensive universal coverage progressives prioritize.

For Conservatives

Empowers small business owners and independent medical practices to compete on a level playing field against large, politically connected hospital conglomerates.
Encourages market competition by removing artificial price distortions that favor institutional providers over efficient independent alternatives.
Protects patient choice by preventing the consolidation of the healthcare market into a few massive entities, preserving the option to see independent physicians.
Constitutes government overreach into the free market by dictating the specific terms of private contracts between insurance companies and healthcare providers.
Expands the administrative state by granting the Health Insurance Commissioner broad authority to promulgate new rules and regulations to enforce the act.
Interferes with the freedom of businesses to negotiate their own pricing structures based on volume, overhead, or other specific market factors.

Votes

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Full Bill Text

Changes to existing Rhode Island law · 28 additions

SECTION 1. Chapter 27-18 of the General Laws entitled "Accident and Sickness Insurance Policies" is hereby amended by adding thereto the following section: 27-18-57.1. Single site parity.

(a) Subject to the provisions of the appropriate federal law, any health insurance contract, plan, or policy delivered or issued for delivery or renewed in this state, shall provide equal reimbursement to independent healthcare facilities, as that of hospital affiliated facilities, where identical healthcare services are provided.

(b) The health insurance commissioner shall promulgate any rules and regulations, as the commissioner deems necessary for the efficient administration and enforcement of this section.

SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service Corporations" is hereby amended by adding thereto the following section: 27-19-48.1. Single site parity.

(a) Subject to the provisions of the appropriate federal law, any health insurance contract, plan, or policy delivered or issued for delivery or renewed in this state, shall provide equal reimbursement to independent healthcare facilities, as that of hospital affiliated facilities where identical healthcare services are provided.

(b) The health insurance commissioner shall promulgate any rules and regulations as the commissioner deems necessary, for the efficient administration and enforcement of this section.

SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service Corporations" is hereby amended by adding thereto the following section: 27-20-43.1. Single site parity.

(a) Subject to the provisions of the appropriate federal law, any health insurance contract, plan, or policy delivered or issued for delivery or renewed in this state, shall provide equal reimbursement to independent healthcare facilities, as that of hospital affiliated facilities where identical healthcare services are provided.

(b) The health insurance commissioner shall promulgate any rules and regulations as the commissioner deems necessary, for the efficient administration and enforcement of this section.

SECTION 4. Chapter 27-41 of the General Laws entitled "Health Maintenance Organizations" is hereby amended by adding thereto the following section: 27-41-59.1. Single site parity.

(a) Subject to the provisions of the appropriate federal law, any health insurance contract, plan, or policy delivered or issued for delivery or renewed in this state, shall provide equal reimbursement to independent healthcare facilities, as that of hospital affiliated facilities where identical healthcare services are provided.

(b) The health insurance commissioner shall promulgate any rules and regulations as the commissioner deems necessary for the efficient administration and enforcement of this section.

SECTION 5. This act shall take effect on January 1, 2027.