AN ACT RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES (Requires healthcare insurers, without prior authorization, to provide post-acute care services to patients discharged from a hospital for a minimum of seven (7) days commencing on or after January 1, 2027.)

H8367

2026 -- H 8367
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LC006194
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STATE OF RHODE ISLAND
IN GENERAL ASSEMBLY
JANUARY SESSION, A.D. 2026
____________
A N A C T
RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

Introduced By:
Representatives Donovan, Kislak, Fogarty, Boylan, Potter, Giraldo,
Furtado, Tanzi, Shallcross Smith, and Ajello

Date Introduced:
March 27, 2026

Referred To:
House Health & Human Services
It is enacted by the General Assembly as follows:
1
SECTION 1. Chapter 27-18 of the General Laws entitled "Accident and Sickness Insurance
2
Policies" is hereby amended by adding thereto the following section:
3

27-18-96. Post-acute care prior authorization.

4

(a) As used in this section:
5

(1) “Post-acute care services” means specialized behavioral, medical, rehabilitative, or
6
homecare services provided to a patient discharged from an acute care hospital to improve the
7
patient’s functional independence and manage the patient’s ongoing health conditions.
8

(b) Every individual or group health insurance contract, or every individual or group
9
hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery,
10
or renewed in this state on or after January 1, 2027 shall provide coverage for post-acute care
11
services, as defined in subsection (a) of this section, for a minimum of seven (7) days and shall not
12
be subject to preauthorization prior to obtaining post-acute care services; provided, the discharging
13
hospital shall provide the insurer with notification prior to discharge and admission to post-acute
14
care; provided further, the utilization review procedures may be initiated on day seven (7). Medical
15
necessity shall be determined by the treating healthcare provider and shall be noted in the patient’s
16
medical record and discharge plan.
17
SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service
18
Corporations" is hereby amended by adding thereto the following section:
19

27-19-88. Post-acute care prior authorization.

1

(a) As used in this section:
2

(1) “Post-acute care services” means specialized behavioral, medical, rehabilitative, or
3
homecare services provided to a patient discharged from an acute care hospital to improve the
4
patient’s functional independence and manage the patient’s ongoing health conditions.
5

(b) Every individual or group health insurance contract, or every individual or group
6
hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery,
7
or renewed in this state on or after January 1, 2027 shall provide coverage for post-acute care
8
services, as defined in subsection (a) of this section, for a minimum of seven (7) days and shall not
9
be subject to preauthorization prior to obtaining post-acute care services; provided, the discharging
10
hospital shall provide the insurer with notification prior to discharge and admission to post-acute
11
care; provided further, the utilization review procedures may be initiated on day seven (7). Medical
12
necessity shall be determined by the treating healthcare provider and shall be noted in the patient’s
13
medical record and discharge plan.
14
SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service
15
Corporations" is hereby amended by adding thereto the following section:
16

27-20-84. Post-acute care prior authorization.

17

(a) As used in this section:
18

(1) “Post-acute care services” means specialized behavioral, medical, rehabilitative, or
19
homecare services provided to a patient discharged from an acute care hospital to improve the
20
patient’s functional independence and manage the patient’s ongoing health conditions.
21

(b) Every individual or group health insurance contract, or every individual or group
22
hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery,
23
or renewed in this state on or after January 1, 2027 shall provide coverage for post-acute care
24
services, as defined in subsection (a) of this section, for a minimum of seven (7) days and shall not
25
be subject to preauthorization prior to obtaining post-acute care services; provided, the discharging
26
hospital shall provide the insurer with notification prior to discharge and admission to post-acute
27
care; provided further, the utilization review procedures may be initiated on day seven (7). Medical
28
necessity shall be determined by the treating healthcare provider and shall be noted in the patient’s
29
medical record and discharge plan.
30
SECTION 4. Chapter 27-41 of the General Laws entitled "Health Maintenance
31
Organizations" is hereby amended by adding thereto the following section:
32

27-41-101. Post-acute care prior authorization.

33

(a) As used in this section:
34

(1) “Post-acute care services” means specialized behavioral, medical, rehabilitative, or

LC006194 - Page 2 of 4
1
homecare services provided to a patient discharged from an acute care hospital to improve the
2
patient’s functional independence and manage the patient’s ongoing health conditions.
3

(b) Every individual or group health insurance contract, or every individual or group
4
hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery,
5
or renewed in this state on or after January 1, 2027 shall provide coverage for post-acute care
6
services, as defined in subsection (a) of this section, for a minimum of seven (7) days and shall not
7
be subject to preauthorization prior to obtaining post-acute care services; provided, the discharging
8
hospital shall provide the insurer with notification prior to discharge and admission to post-acute
9
care; provided further, the utilization review procedures may be initiated on day seven (7). Medical
10
necessity shall be determined by the treating healthcare provider and shall be noted in the patient’s
11
medical record and discharge plan.
12
SECTION 5. 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 -- ACCIDENT AND SICKNESS INSURANCE POLICIES
***
1
This act would require healthcare insurers, without prior authorization, to provide post-
2
acute care services to patients discharged from a hospital for a minimum of seven (7) days
3
commencing on or after January 1, 2027.
4
This act would take effect upon passage.
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LC006194
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