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S2109aa
2026 -- S 2109 AS AMENDED
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LC003217
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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 -- BENEFIT DETERMINATION AND UTILIZATION
REVIEW ACT
Introduced By:
Senators Urso, DiMario, Kallman, Murray, Acosta, Rogers, Gu, and
Date Introduced:
January 16, 2026
Referred To:
Senate Health & Human Services
It is enacted by the General Assembly as follows:
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SECTION 1. Chapter 27-18.9 of the General Laws entitled "Benefit Determination and
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Utilization Review Act" is hereby amended by adding thereto the following section:
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27-18.9-17. Utilization review decisions for the treatment of alcohol or substance use
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disorder.
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(a) A utilization review decision shall not retrospectively deny coverage for healthcare
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service provided to a covered person, when prior approval has been obtained from the insurer or its
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designee for those services, unless the approval was based upon fraudulent, materially inaccurate,
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or misrepresented information submitted by the covered person, authorized person, or the provider.
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(b) For health benefit plans issued or renewed on or after January 1, 2027, an insurer or
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shall not require or conduct a prospective or concurrent review for a prescription medicine:
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(1) That is used for the treatment of alcohol or opioid use disorder; (2) That contains
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methadone, buprenorphine or naltrexone; or
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(3) That was approved before January 1, 2027, by the United States Food and Drug
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Administration for the management of alcohol or opioid use disorder, or the mitigation of opioid
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withdrawal symptoms.
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SECTION 2. Chapter 40-8 of the General Laws entitled "Medical Assistance" is hereby
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amended by adding thereto the following section:
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40-8-33. Utilization reviews for Medicaid benefits.
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In conducting utilization reviews for Medicaid benefits, each Medicaid managed care
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organization shall use the medical necessity criteria selected by the executive office of health and
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human services for making determinations of medical necessity and clinical appropriateness
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pursuant to the utilization review plan.
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SECTION 3. 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 -- BENEFIT DETERMINATION AND UTILIZATION
REVIEW ACT
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This act would prohibit healthcare insurers or pharmacy benefit managers from requiring
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or conducting a review for prescription medicine that is used in the treatment of alcohol or opioid
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use disorder, that contains methadone, burenorphine, or naltrexone or that was approved for the
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mitigation of opioid withdrawal symptoms.
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This act would take effect upon passage.
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