AN ACT RELATING TO INSURANCE -- INSURANCE COVERAGE FOR MENTAL ILLNESS AND SUBSTANCE USE DISORDERS (Prohibits health insurance providers from requiring preauthorization for in-network mental health or substance use disorder services.)

H7943

2026 -- H 7943
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LC005811
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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 -- INSURANCE COVERAGE FOR MENTAL ILLNESS AND
SUBSTANCE USE DISORDERS

Introduced By:
Representatives Tanzi, McGaw, Alzate, Spears, Speakman, Donovan,
Batista, Shanley, Stewart, and Kislak

Date Introduced:
February 27, 2026

Referred To:
House Health & Human Services
It is enacted by the General Assembly as follows:
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SECTION 1. Section 27-38.2-1 of the General Laws in Chapter 27-38.2 entitled "Insurance
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Coverage for Mental Illness and Substance Use Disorders" is hereby amended to read as follows:
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27-38.2-1. Coverage for treatment of mental health and substance use disorders.
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(a) A group health plan and an individual or group health insurance plan shall provide
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coverage for the treatment of mental health and substance use disorders under the same terms and
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conditions as that coverage is provided for other illnesses and diseases.
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(b) Coverage for the treatment of mental health and substance use disorders shall not
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impose any annual or lifetime dollar limitation.
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(c) Financial requirements and quantitative treatment limitations on coverage for the
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treatment of mental health and substance use disorders shall be no more restrictive than the
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predominant financial requirements applied to substantially all coverage for medical conditions in
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each treatment classification.
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(d) Coverage shall not impose non-quantitative treatment limitations for the treatment of
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mental health and substance use disorders unless the processes, strategies, evidentiary standards,
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or other factors used in applying the non-quantitative treatment limitation, as written and in
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operation, are comparable to, and are applied no more stringently than, the processes, strategies,
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evidentiary standards, or other factors used in applying the limitation with respect to
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medical/surgical benefits in the classification.

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(e) The following classifications shall be used to apply the coverage requirements of this
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chapter: (1) Inpatient, in-network; (2) Inpatient, out-of-network; (3) Outpatient, in-network; (4)
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Outpatient, out-of-network; (5) Emergency care; and (6) Prescription drugs.
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(f) Medication-assisted treatment or medication-assisted maintenance services of substance
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use disorders, opioid overdoses, and chronic addiction, including methadone, buprenorphine,
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naltrexone, or other clinically appropriate medications, is included within the appropriate
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classification based on the site of the service.
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(g) Payors shall rely upon the criteria of the American Society of Addiction Medicine when
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developing coverage for levels of care for substance use disorder treatment.
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(h) Patients with substance use disorders shall have access to evidence-based, non-opioid
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treatment for pain, therefore coverage shall apply to medically necessary chiropractic care and
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osteopathic manipulative treatment performed by an individual licensed under § 5-37-2.
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(i) Parity of cost-sharing requirements. Regardless of the professional license of the
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provider of care, if that care is consistent with the provider’s scope of practice and the health plan’s
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credentialing and contracting provisions, cost sharing for behavioral health counseling visits and
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medication maintenance visits shall be consistent with the cost sharing applied to primary care
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office visits.
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(j) No health insurers shall require prior authorization, for in-network inpatient and in-
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network outpatient mental health or substance use disorder services. The office of the health
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insurance commissioner shall promulgate rules and regulations and conduct oversight and
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enforcement actions necessary to implement this subsection, including the imposition of fines for
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violations.
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SECTION 2. This act shall take effect on January 1, 2027.
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EXPLANATION
BY THE LEGISLATIVE COUNCIL
OF
A N A C T
RELATING TO INSURANCE -- INSURANCE COVERAGE FOR MENTAL ILLNESS AND
SUBSTANCE USE DISORDERS
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This act would prohibit health insurance providers from requiring preauthorization for in-
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network mental health or substance use disorder services.
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This act would take effect on January 1, 2027.
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LC005811
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