AN ACT RELATING TO INSURANCE -- HEALTHCARE ACCESSIBILITY AND QUALITY ASSURANCE ACT (Prohibits unilateral modification of healthcare provider contracts.)

H7862

2026 -- H 7862
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LC005437
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STATE OF RHODE ISLAND
IN GENERAL ASSEMBLY
JANUARY SESSION, A.D. 2026
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A N A C T
RELATING TO INSURANCE -- HEALTHCARE ACCESSIBILITY AND QUALITY
ASSURANCE ACT

Introduced By:
Representative Mia A. Ackerman

Date Introduced:
February 27, 2026

Referred To:
House Corporations
(by request)
It is enacted by the General Assembly as follows:
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SECTION 1. Chapter 27-18.8 of the General Laws entitled "Healthcare Accessibility and
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Quality Assurance Act" is hereby amended by adding thereto the following section:
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27-18.8-3.1. Unilateral modification of provider contracts prohibited.

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(a) No healthcare entity, as defined in § 27-18.8-2, including any affiliate, subsidiary, or
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contracted vendor acting on behalf of the healthcare entity, that offers, issues, or renews a health
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plan in this state, shall unilaterally modify, amend, or reinterpret any material term or condition of
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a contract with a healthcare provider, during the term of such contract.
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(b) For purposes of this section, a "material term or condition" means and includes, but is
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not limited to, changes to reimbursement methodologies or underlying fee schedules; payment
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terms; carrier policies, protocols, or procedures; definitions of covered services or covered sites of
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service; utilization review requirements, prior authorization requirements, or medical necessity
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criteria; quality management or quality improvement requirements; credentialing requirements;
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billing or documentation requirements; clinical policy bulletins or coverage determination or
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covered preventive health services.
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(c) Material terms and conditions shall include any policy, protocol, fee schedule, provider
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manual, or guidance incorporated by reference into the contract, whether issued electronically or
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otherwise.
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(d) A healthcare entity may implement changes to a health carrier contract only:

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(1) Upon the mutual written agreement of the healthcare entity and the healthcare provider;
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or
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(2) Where such change is expressly required by state or federal law.
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(e) Any change not required by law shall not take effect until the renewal of the contract
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term and then only if the healthcare entity has provided written notice of the proposed change at
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least ninety (90) days before the renewal.
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SECTION 2. This act shall take effect upon passage.
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EXPLANATION
BY THE LEGISLATIVE COUNCIL
OF
A N A C T
RELATING TO INSURANCE -- HEALTHCARE ACCESSIBILITY AND QUALITY
ASSURANCE ACT
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This act would prohibit a healthcare entity from unilaterally modifying amending or
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reinterpreting any material term or condition of a contact with a healthcare provider during the term
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of such contact.
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This act would take effect upon passage.
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LC005437
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LC005437 - Page 3 of 3