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S2108aaHealth Insurance

Insurance - Accident and Sickness Insurance Policies

This bill requires health insurance companies to pay behavioral health service providers at least the state's approved Medicaid rate.

Introduced37 Yea0 Nay1 Not voting
Population
Affected
35
Email Legislator
Introduced Jan 16, 2026Committee Senate Health & Human Services

Plain-English Summary

This bill updates state laws regarding health insurance rates for various types of insurance companies and health maintenance organizations. It specifically requires that these insurance companies must not pay a rate for behavioral health services that is lower than the approved Medicaid rate set by the state's Executive Office of Health and Human Services. This applies to stock or mutual corporations that have merged with or acquired significant assets of nonprofit hospital or medical service corporations. The insurance companies must also continue to document their cost structures to the insurance commissioner.

For younger readers

This bill changes the rules for health insurance companies. Health insurance is what helps people pay for their doctor visits. Behavioral health services are treatments for things like feelings, moods, or mental health. The bill says that when insurance companies pay doctors or therapists for these behavioral health services, they cannot pay them less than a specific amount. That specific amount is the minimum rate set by Medicaid, which is a government program that helps pay for healthcare.

Who & Where It Applies

Impacted groups
Behavioral health providersHealth insurance companiesPatients seeking mental health carePolicyholdersState insurance regulators
Impacted communities
All

Constitutional & Fiscal Check

None Likely

Estimated cost
None
Estimated revenue
None

Bill Analysis

Both viewpoints
For Progressives
  • Ensures behavioral health providers receive a guaranteed minimum payment, which supports the mental health workforce and strengthens the social safety net.
  • May increase the number of providers willing to accept insurance by preventing underpayment, thereby improving access to essential mental health care for the community.
  • Promotes corporate accountability by restricting large, for-profit insurance companies from shortchanging behavioral health services to maximize their own profits.
  • Relies on Medicaid rates, which are often historically low, potentially normalizing inadequate compensation for mental health professionals rather than establishing a true living wage.
  • Maintains reliance on a private, corporate insurance model rather than advancing systemic reform toward a universal, government-funded healthcare system.
  • Only applies to specific insurance companies that have merged with or acquired nonprofits, potentially leaving loopholes that allow other insurers to continue underpaying for services.
For Conservatives
  • Provides a clear, predictable financial baseline for insurance companies to model their costs around without imposing arbitrary, government-invented price caps.
  • Ensures behavioral health providers are compensated through the private market rather than relying on new taxpayer-funded government assistance programs.
  • Preserves the role of the private insurance industry in managing healthcare services instead of shifting toward a fully government-run healthcare model.
  • Restricts corporate freedom by explicitly dictating the minimum rates private insurance companies are allowed to pay healthcare providers.
  • Interferes with free-market dynamics by forcing private businesses to tie their payment structures to government-set Medicaid rates.
  • Imposes unnecessary regulatory burdens on insurance companies by requiring them to submit sworn accounting documents to the state insurance commissioner.

Votes

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Full Bill Text

2 versions
Changes to existing Rhode Island law · 18 additions · 4 deletions

SECTION 1. Section 27-18-54 of the General Laws in Chapter 27-18 entitled "Accident and Sickness Insurance Policies" is hereby amended to read as follows: 27-18-54. Health insurance rates. No insurance company organized as a stock or mutual corporation that merges or consolidates with, acquires ownership or control or possession of twenty percent (20%) or greater of the operating assets of, or otherwise acquires control of a nonprofit hospital service corporation organized under chapter 19 of this title, a nonprofit medical service corporation organized under chapter 20 of this title, or a health maintenance organization organized under chapter 41 of this title may: (1) File with any state agency for review or approval any proposed rate to be used by the company in the state; or (2) Charge to any party in the state any rate or premium, that takes into account or reflects in any manner the value of any contribution, distribution, or allocation the company expends or incurs in establishing or funding a charitable foundation organized to maintain or account for the assets of a nonprofit hospital service corporation, nonprofit medical service corporation, or health maintenance organization; or (3) Pay a rate that is less than the approved Medicaid rate for behavioral health services set by the executive office of health and human services. For any rate that is to be charged to policy holders, regardless of whether the rate is subject to approval by a state agency under this or another chapter, the company shall at least thirty (30) days before implementing the rate submit under oath to the commissioner of insurance an accounting that documents the cost structure on which the rate is based and demonstrates the company’s compliance with this section.

SECTION 2. Section 27-19-30.1 of the General Laws in Chapter 27-19 entitled "Nonprofit Hospital Service Corporations" is hereby amended to read as follows: 27-19-30.1. Health insurance rates. No insurance company organized as a stock or mutual corporation that merges or consolidates with, acquires ownership or control or possession of twenty percent (20%) or greater of the operating assets of, or otherwise acquires control of a nonprofit hospital service corporation organized under this chapter, a nonprofit medical service corporation organized under chapter 20 of this title, or a health maintenance organization organized under chapter 41 of this title, may: (1) File with any state agency for review or approval any proposed rate to be used by the company in the state, or; (2) Charge to any party in the state any rate or premium that takes into account or reflects in any manner the value of any contribution, distribution, or allocation the company expends or incurs in establishing or funding a charitable foundation organized to maintain or otherwise account for the assets of a nonprofit hospital service corporation, nonprofit medical service corporation, or health maintenance organization; or (3) Pay a rate that is less than the approved Medicaid rate for behavioral health services set by the executive office of health and human services. For any rate that is to be charged to policyholders, regardless of whether the rate is subject to approval by a state agency under this or another chapter, the company shall at least thirty (30) days before implementing the rate submit under oath to the commissioner of insurance an accounting that documents the cost structure on which the rate is based and demonstrates the company’s compliance with this section.

SECTION 3. Section 27-20-25.2 of the General Laws in Chapter 27-20 entitled "Nonprofit Medical Service Corporations" is hereby amended to read as follows: 27-20-25.2. Health insurance rates. No insurance company organized as a stock or mutual corporation that merges or consolidates with; acquires ownership or control or possession of twenty percent (20%) or greater of the operating assets of; or acquires control of a nonprofit hospital service corporation organized under chapter 19 of this title, a nonprofit medical service corporation organized under this chapter, or a health maintenance organization organized under chapter 41 of this title may: (1) File with any state agency for review or approval any proposed rate to be used by the company in the state, or;

(2) Charge to any party in the state any rate or premium, that takes into account or reflects in any manner the value of any contribution, distribution, or allocation the company expends or incurs in establishing or funding a charitable foundation organized to maintain or account for the assets of a nonprofit hospital service corporation, nonprofit medical service corporation, or health maintenance organization; or (3) Pay a rate that is less than the approved Medicaid rate for behavioral health services set by the executive office of health and human services. For any rate that is to be charged to policyholders, regardless of whether this rate is subject to approval by a state agency under this or another chapter, the company shall at least thirty (30) days before implementing the rate submit under oath to the commissioner of insurance an accounting that documents the cost structure on which the rate is based and demonstrates the company’s compliance with this section.

SECTION 4. Section 27-41-27.2 of the General Laws in Chapter 27-41 entitled "Health Maintenance Organizations" is hereby amended to read as follows: 27-41-27.2. Health insurance rates. No insurance company organized as a stock or mutual corporation that merges or consolidates with, acquires ownership or control or possession of twenty percent (20%) or greater of the operating assets of, or acquires control of a nonprofit hospital service corporation organized under chapter 19 of this title, a nonprofit medical service corporation organized under chapter 20 of this title, or a health maintenance organization organized under chapter 41 of this title: (1) May file with any state agency for review or approval any proposed rate to be used by the company in the state, or; (2) May charge to any party in the state any rate or premium, that takes into account or reflects in any manner the value of any contribution, distribution, or allocation the company expends or incurs in establishing or funding a charitable foundation organized to maintain or account for the assets of a nonprofit hospital service corporation, nonprofit medical service corporation, or health maintenance organization; or (3) Pay a rate that is less than the approved Medicaid rate for behavioral health services set by the executive office of health and human services. For any rate that is to be charged to policyholders, regardless of whether this rate is subject to approval by a state agency under this or another chapter, the company shall at least thirty (30) days before implementing the rate submit under oath to the commissioner of insurance an accounting that documents the cost structure on which the rate is based and demonstrates the company’s compliance with this section.

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