RI 2026 H8367: Insurance - Accident and Sickness Insurance Policies

Plain-English Summary

This bill requires health insurance companies in Rhode Island to cover at least seven days of post-acute care services without requiring prior authorization. Post-acute care includes specialized behavioral, medical, rehabilitative, or homecare services for patients discharged from a hospital. The hospital must notify the insurance company before the patient is discharged and admitted to post-acute care. The treating healthcare provider is responsible for determining if the care is medically necessary. Insurance companies can begin their standard review procedures on the seventh day of care. These rules apply to insurance plans issued or renewed starting January 1, 2027.

For younger readers

When someone is very sick and leaves the hospital, they sometimes still need extra medical help or physical therapy before going home. This extra help is called "post-acute care." This bill makes a rule for health insurance companies, which are businesses that help pay for medical bills. Starting in 2027, the rule says insurance companies must pay for the first seven days of this extra help without making the doctor ask for permission first. The doctor gets to decide if the patient needs this extra help.

Who & Where It Applies

Impacted groups

Hospital patientsHealthcare providersHealth insurance companiesAcute care hospitalsPost-acute care facilities

Impacted communities

All

Constitutional & Fiscal Check

None Likely

Estimated cost

None

Estimated revenue

None

Bill Analysis

Both viewpoints

For Progressives

Removes bureaucratic barriers to essential healthcare services, ensuring patients receive immediate post-hospitalization care without dangerous delays.
Empowers medical professionals rather than corporate insurance companies to determine medical necessity, prioritizing patient well-being over corporate profits.
Strengthens the social safety net by guaranteeing at least seven days of continuous care, which disproportionately benefits vulnerable patients who cannot afford out-of-pocket costs while waiting for insurance approvals.
The seven-day limit before utilization review kicks in may still leave patients vulnerable to sudden cutoffs in care if the insurer denies further coverage after the initial period.
The protections do not go into effect for policies until January 1, 2027, meaning patients will continue to face prior authorization hurdles for several more years.
Does not address the underlying out-of-pocket costs, copays, or deductibles associated with post-acute care, which may still make these services unaffordable for low-income individuals.

For Conservatives

Empowers individual healthcare providers and private practice doctors to make medical decisions without immediate interference from large insurance bureaucracies.
May reduce costly hospital readmissions and free up hospital beds faster, creating a more efficient healthcare market and reducing overall systemic costs.
Streamlines the discharge process for hospitals, reducing administrative red tape and overhead costs associated with fighting for initial insurance approvals.
Imposes strict government mandates on private insurance companies, interfering with corporate freedom and their ability to freely manage risk and control costs.
Prohibiting prior authorization for seven days could lead to increased instances of unnecessary care, driving up insurance premiums for all consumers.
Creates new regulatory burdens on the free market by dictating exactly what services must be covered and how medical necessity is determined by state law rather than private contract.

Votes

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Full Bill Text

Changes to existing Rhode Island law · 56 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: 27-18-96. Post-acute care prior authorization.

(a) As used in this section:

(1) “Post-acute care services” means specialized behavioral, medical, rehabilitative, or homecare services provided to a patient discharged from an acute care hospital to improve the patient’s functional independence and manage the patient’s ongoing health conditions.

(b) Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state on or after January 1, 2027 shall provide coverage for post-acute care services, as defined in subsection (a) of this section, for a minimum of seven (7) days and shall not be subject to preauthorization prior to obtaining post-acute care services; provided, the discharging hospital shall provide the insurer with notification prior to discharge and admission to post-acute care; provided further, the utilization review procedures may be initiated on day seven (7). Medical necessity shall be determined by the treating healthcare provider and shall be noted in the patient’s medical record and discharge plan.

SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service Corporations" is hereby amended by adding thereto the following section: 27-19-88. Post-acute care prior authorization.

(a) As used in this section:

(1) “Post-acute care services” means specialized behavioral, medical, rehabilitative, or homecare services provided to a patient discharged from an acute care hospital to improve the patient’s functional independence and manage the patient’s ongoing health conditions.

(b) Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state on or after January 1, 2027 shall provide coverage for post-acute care services, as defined in subsection (a) of this section, for a minimum of seven (7) days and shall not be subject to preauthorization prior to obtaining post-acute care services; provided, the discharging hospital shall provide the insurer with notification prior to discharge and admission to post-acute care; provided further, the utilization review procedures may be initiated on day seven (7). Medical necessity shall be determined by the treating healthcare provider and shall be noted in the patient’s medical record and discharge plan.

SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service Corporations" is hereby amended by adding thereto the following section: 27-20-84. Post-acute care prior authorization.

(a) As used in this section:

(1) “Post-acute care services” means specialized behavioral, medical, rehabilitative, or homecare services provided to a patient discharged from an acute care hospital to improve the patient’s functional independence and manage the patient’s ongoing health conditions.

(b) Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state on or after January 1, 2027 shall provide coverage for post-acute care services, as defined in subsection (a) of this section, for a minimum of seven (7) days and shall not be subject to preauthorization prior to obtaining post-acute care services; provided, the discharging hospital shall provide the insurer with notification prior to discharge and admission to post-acute care; provided further, the utilization review procedures may be initiated on day seven (7). Medical necessity shall be determined by the treating healthcare provider and shall be noted in the patient’s medical record and discharge plan.

SECTION 4. Chapter 27-41 of the General Laws entitled "Health Maintenance Organizations" is hereby amended by adding thereto the following section: 27-41-101. Post-acute care prior authorization.

(a) As used in this section:

(1) “Post-acute care services” means specialized behavioral, medical, rehabilitative, or homecare services provided to a patient discharged from an acute care hospital to improve the patient’s functional independence and manage the patient’s ongoing health conditions.

(b) Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state on or after January 1, 2027 shall provide coverage for post-acute care services, as defined in subsection (a) of this section, for a minimum of seven (7) days and shall not be subject to preauthorization prior to obtaining post-acute care services; provided, the discharging hospital shall provide the insurer with notification prior to discharge and admission to post-acute care; provided further, the utilization review procedures may be initiated on day seven (7). Medical necessity shall be determined by the treating healthcare provider and shall be noted in the patient’s medical record and discharge plan.

SECTION 5. This act shall take effect upon passage.