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S 3061Health Insurance

Insurance - Accident and Sickness Insurance Policies

Health insurers must cover seven days of post-hospital rehab or home care without requiring advance approval, starting in 2027.

Introduced38 Yea0 Nay0 Not voting
Population
Affected
35
Email Legislator
Introduced Mar 12, 2026Committee Senate Health & Human Services

Plain-English Summary

This legislation mandates that health insurance policies issued or renewed in Rhode Island on or after January 1, 2027, must cover post-acute care services—such as rehabilitation, skilled nursing, or home care—for a minimum of seven days after a hospital discharge. Crucially, insurers cannot require prior authorization for this initial seven-day period. The treating healthcare provider determines medical necessity. While the hospital must notify the insurer of the discharge and admission to post-acute care, the insurance company cannot begin its own review process to approve or deny further coverage until the seventh day.

For younger readers

When someone is sick enough to stay in a hospital, they often need extra help getting better after they leave. This might mean going to a special center for exercises or having a nurse visit their home. Usually, insurance companies want to say "yes" or "no" before this happens, which can take time. This bill says that insurance companies have to pay for this help for at least one week without asking questions first. The doctor decides if the patient needs it. This rule starts in the year 2027.

Who & Where It Applies

Impacted groups
Patients requiring rehabilitationHealth insurance companiesHospitalsDoctorsNursing homes
Impacted communities
All

Constitutional & Fiscal Check

None Likely

Estimated cost
None
Estimated revenue
None

Bill Analysis

Both viewpoints
For Progressives
  • Eliminates administrative barriers imposed by private insurance companies that often delay critical recovery services, ensuring patients receive immediate care upon hospital discharge regardless of bureaucratic approval processes.
  • Shifts the authority for determining medical necessity back to treating healthcare providers rather than corporate insurance adjusters, prioritizing patient health outcomes over profit margins.
  • Prevents patients from getting stuck in acute care hospitals unnecessarily while waiting for approvals, thereby streamlining the transition to rehabilitation or home care settings which is vital for vulnerable populations.
  • The implementation date is delayed until January 2027, meaning patients will continue to face bureaucratic delays and coverage denials for several years before this relief takes effect.
  • Guarantees only seven days of coverage before utilization review begins, which may be insufficient for patients with complex recovery needs or severe disabilities who require longer guaranteed support.
  • Insurance companies may pass the potential costs of unreviewed care onto consumers through higher premiums or deductibles, which disproportionately affects lower-income individuals and families.
For Conservatives
  • Increases the efficiency of the healthcare system by allowing hospitals to discharge patients more quickly, ensuring acute care beds are available for those who critically need them rather than being occupied by administrative delays.
  • Empowers medical professionals to make immediate treatment decisions regarding their patients without interference from administrative third parties, respecting the autonomy of the doctor-patient relationship.
  • Ensures that individuals and families can access necessary post-hospitalization care immediately, supporting the stability of the family unit during medical crises without government-induced or bureaucratic waiting periods.
  • Imposes heavy-handed government mandates on private insurance contracts, interfering with the free market and the right of businesses to manage their own risk and cost-control measures.
  • Likely to drive up insurance premiums for all policyholders as companies are forced to pay for services that may not have been approved under standard review processes.
  • Removes necessary checks and balances for the first week of care, potentially encouraging fraud or the utilization of unnecessary services at the expense of the premium-paying public.

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.