S 2467Health Insurance

Insurance - Insurance Coverage for Mental Illness and Substance Use Disorders

This bill bans health insurers from requiring prior authorization for in-network mental health and substance use disorder treatments.

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Introduced Feb 6, 2026Committee Senate Health & Human Services

Plain-English Summary

This legislation amends existing insurance laws to improve access to mental health and substance use disorder treatments. The key provision prohibits health insurance companies from requiring "prior authorization" for in-network inpatient and outpatient services for these conditions. This means patients and doctors will not need to seek advance permission from the insurance company before treatment begins. Additionally, the bill mandates that the Office of the Health Insurance Commissioner create regulations to enforce this rule and allows the office to fine insurers that fail to comply. The law takes effect in 2027.

For younger readers

When people are sick or need help with their feelings, they see a doctor. Usually, the companies that pay for the doctor (called insurance companies) make the doctor ask for permission before they can help the patient. This bill makes a new rule that says insurance companies cannot make doctors ask for permission first when a person needs help with mental health or problems with drugs or alcohol. This helps people get the care they need much faster without waiting for the insurance company to say "yes."

Who & Where It Applies

Impacted groups

Health insurance companiesPatients with mental health conditionsPatients with substance use disordersHealthcare providersOffice of the Health Insurance Commissioner

Impacted communities

All

Constitutional & Fiscal Check

None Likely

Estimated cost

None

Estimated revenue

Amount unknown

Bill Analysis

Both viewpoints

For Progressives

Eliminates significant administrative barriers to care, ensuring that individuals seeking help for mental health and substance use disorders can access treatment immediately without bureaucratic delays.
Promotes health equity by treating mental healthcare with the same urgency and accessibility as emergency medical care, reducing stigmatization and systemic hurdles for vulnerable populations.
Empowers state regulators to hold private insurance corporations accountable through oversight and fines, protecting consumers from profit-driven denial of services.
The effective date is delayed until January 1, 2027, leaving patients vulnerable to barrier-laden access to care for several more years despite the immediate need.
The prohibition on prior authorization applies only to in-network services, potentially leaving patients who live in areas with provider shortages still facing barriers if they must go out-of-network.
Private insurers may attempt to offset the perceived cost risks of this mandate by raising premiums, which could disproportionately impact lower-income individuals purchasing their own plans.

For Conservatives

Reduces the administrative burden and red tape for medical providers and hospitals, allowing them to focus on patient care rather than paperwork and phone calls with insurers.
Ensures that individuals receive the services they have paid for through their premiums without arbitrary interference or breach of contract by insurance carriers.
May help address the public safety and community costs associated with untreated substance abuse and mental illness by facilitating quicker treatment.
Represents significant government interference in the free market by dictating the terms of business contracts and risk management strategies between private insurers and providers.
Will likely result in increased insurance premiums for all ratepayers, as insurers pass on the costs of uncontrolled utilization and the inability to manage care efficiently.
Expands the size and power of the administrative state by granting the Office of the Health Insurance Commissioner broad authority to promulgate 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.