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H 7943Health Insurance

Insurance - Insurance Coverage for Mental Illness and Substance Use Disorders

This bill bans insurance companies from requiring prior authorization for mental health services and lowers copays for therapy.

Held for study
Population
Affected
45
Email Legislator
Introduced Feb 27, 2026Committee House Health & Human Services

Plain-English Summary

This legislation amends existing insurance laws to ensure greater parity between mental health/substance use disorder treatments and standard medical care. Specifically, it mandates that cost-sharing requirements (such as copays) for behavioral health counseling and medication maintenance must be consistent with those for primary care visits. A significant change introduced by this bill is the prohibition of prior authorization requirements for in-network inpatient and outpatient services for mental health and substance use disorders. It authorizes the Office of the Health Insurance Commissioner to enforce these rules and levy fines for non-compliance.

For younger readers

This new rule helps people who need to see a special doctor for their feelings or because they are having trouble with drugs or alcohol. Sometimes, insurance companies make doctors ask for permission before they can help a sick person. This rule says the insurance company cannot do that anymore for these problems; the doctor can just help right away. It also says that going to these special doctors shouldn't cost more money than going to a regular doctor for a check-up.

Who & Where It Applies

Impacted groups
Patients with mental health conditionsPatients with substance use disordersHealth insurance companiesMental health providersChiropractors
Impacted communities
All

Constitutional & Fiscal Check

None Likely

Estimated cost
None
Estimated revenue
Amount unknown

Bill Analysis

Both viewpoints
For Progressives
  • Significantly increases access to healthcare by removing "prior authorization" barriers, ensuring people in crisis receive immediate mental health and substance use treatment without bureaucratic delays.
  • Promotes economic justice by mandating that copays for behavioral health match primary care visits, reducing the financial burden on working-class individuals seeking therapy.
  • Strengthens the social safety net by empowering a government agency (OHIC) to strictly enforce these rules and fine corporations that attempt to restrict care access.
  • The legislation does not take effect until January 1, 2027, leaving vulnerable populations subject to current restrictive insurance practices for several more years.
  • The bill only prohibits prior authorization for "in-network" providers, potentially leaving patients who live in areas with provider shortages without affordable, immediate access to care.
  • Relies on the private insurance market structure rather than establishing a universal public option for mental health care, maintaining the profit motive in healthcare.
For Conservatives
  • Encourages the use of non-opioid pain treatments, such as chiropractic care, which may help reduce societal reliance on addictive pharmaceuticals.
  • Reduces administrative red tape for healthcare providers by eliminating the time-consuming prior authorization process for specific services.
  • Clarifies billing structures by aligning behavioral health cost-sharing with primary care, potentially making pricing more predictable for consumers.
  • Represents a significant government intrusion into the free market by dictating the specific terms and operational procedures of private insurance contracts.
  • Eliminating prior authorization removes a key tool insurers use to control costs and prevent fraud, which will likely result in higher insurance premiums for all policyholders.
  • Expands the power of the administrative state by granting the Office of the Health Insurance Commissioner broad authority to create new regulations and levy fines.

Votes

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Full Bill Text

Changes to existing Rhode Island law · 6 additions

SECTION 1. Section 27-38.2-1 of the General Laws in Chapter 27-38.2 entitled "Insurance Coverage for Mental Illness and Substance Use Disorders" is hereby amended to read as follows: 27-38.2-1. Coverage for treatment of mental health and substance use disorders.

(a) A group health plan and an individual or group health insurance plan shall provide coverage for the treatment of mental health and substance use disorders under the same terms and conditions as that coverage is provided for other illnesses and diseases.

(b) Coverage for the treatment of mental health and substance use disorders shall not impose any annual or lifetime dollar limitation.

(c) Financial requirements and quantitative treatment limitations on coverage for the treatment of mental health and substance use disorders shall be no more restrictive than the predominant financial requirements applied to substantially all coverage for medical conditions in each treatment classification.

(d) Coverage shall not impose non-quantitative treatment limitations for the treatment of mental health and substance use disorders unless the processes, strategies, evidentiary standards, or other factors used in applying the non-quantitative treatment limitation, as written and in operation, are comparable to, and are applied no more stringently than, the processes, strategies, evidentiary standards, or other factors used in applying the limitation with respect to medical/surgical benefits in the classification.

(e) The following classifications shall be used to apply the coverage requirements of this chapter: (1) Inpatient, in-network; (2) Inpatient, out-of-network; (3) Outpatient, in-network; (4) Outpatient, out-of-network; (5) Emergency care; and (6) Prescription drugs.

(f) Medication-assisted treatment or medication-assisted maintenance services of substance use disorders, opioid overdoses, and chronic addiction, including methadone, buprenorphine, naltrexone, or other clinically appropriate medications, is included within the appropriate classification based on the site of the service.

(g) Payors shall rely upon the criteria of the American Society of Addiction Medicine when developing coverage for levels of care for substance use disorder treatment.

(h) Patients with substance use disorders shall have access to evidence-based, non-opioid treatment for pain, therefore coverage shall apply to medically necessary chiropractic care and osteopathic manipulative treatment performed by an individual licensed under § 5-37-2.

(i) Parity of cost-sharing requirements. Regardless of the professional license of the provider of care, if that care is consistent with the provider’s scope of practice and the health plan’s credentialing and contracting provisions, cost sharing for behavioral health counseling visits and medication maintenance visits shall be consistent with the cost sharing applied to primary care office visits.

(j) No health insurers shall require prior authorization, for in-network inpatient and in- network outpatient mental health or substance use disorder services. The office of the health insurance commissioner shall promulgate rules and regulations and conduct oversight and enforcement actions necessary to implement this subsection, including the imposition of fines for violations.

SECTION 2. This act shall take effect on January 1, 2027.