AN ACT RELATING TO INSURANCE -- EQUITABLE FUNDING FOR HEALTHCARE PROVIDER BAD DEBT (Establishes a procedure for a health insurer to reimburse a healthcare provider no less than sixty-five percent (65%) of each unpaid co-payment, co-insurance or deductible amount due, after reasonable collection efforts.)

S3088

2026 -- S 3088
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LC006057
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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 -- EQUITABLE FUNDING FOR HEALTHCARE PROVIDER
BAD DEBT

Introduced By:
Senators Dimitri, Patalano, LaMountain, Bissaillon, Quezada,
McKenney, and Raptakis

Date Introduced:
March 13, 2026

Referred To:
Senate Health & Human Services
It is enacted by the General Assembly as follows:
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SECTION 1. Title 27 of the General Laws entitled "INSURANCE" is hereby amended by
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adding thereto the following chapter:
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CHAPTER 18.10
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EQUITABLE FUNDING FOR HEALTHCARE PROVIDER BAD DEBT
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28-18.10-1. Definitions.
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When used in this chapter, the following words and phrases are construed as follows:
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(1) “Co-insurance” means a percentage of the allowed amount, after a co-payment, if any,
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that an insured must pay for covered services received under a health benefit plan for healthcare
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services provided and billed by a healthcare provider.
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(2) “Co-payment” means a fixed dollar amount that is owed by an insured as required under
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a health benefit plan for healthcare services provided and billed by a healthcare provider.
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(3) “Deductible” means a specific dollar amount that an insured must pay for covered
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services before the health insurer’s health benefit plan becomes obligated to pay for covered
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healthcare services provided and billed by a healthcare provider; such deductible does not include
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any portion of premiums paid by an insured.
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(4) “Health insurance commissioner” means that individual appointed pursuant to § 42-
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14.5-1.
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28-18.10-2. Reimbursement.

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(a) Notwithstanding any other provision of the general laws to the contrary, a health insurer
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shall reimburse a healthcare provider no less than sixty-five percent (65%) of each co-payment, co-
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insurance and/or deductible amount due under an insured’s health benefit plan which is unpaid after
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reasonable collection efforts have been made by the healthcare provider pursuant to subsection (b)
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of this section.
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(b) Reimbursement for uncollected co-payment, co-insurance and/or deductible amounts
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due (each a “claim”) under an insured’s health benefit plan for covered services rendered shall be
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deemed an uncollectible bad debt, and a healthcare provider may submit a request for
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reimbursement to the health insurer under the following conditions:
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(1) The claim must be derived from the wholly or partially uncollected co-payment, co-
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insurance and/or deductible amounts under an insured’s health benefit plan;
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(2) The reimbursement requested by the healthcare provider shall be for a claim where the
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co-payment, co-insurance, or deductible amount was at least two hundred fifty dollars ($250), and
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each claim reflects a unique covered service under the health benefit plan per insured;
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(3) The healthcare provider must have made reasonable collection efforts for each claim
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filed for reimbursement under this section, such efforts including documentation that the claim has
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remained partially or fully unpaid and is not subject to an ongoing payment plan for more than one
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hundred twenty (120) days from the date the first bill was mailed, which may include such efforts
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as telephone calls, collection letters, or any other notification method that constitutes a genuine and
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continuous effort to contact the member. Said documentation shall include the date and method of
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contact;
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(4) On or before May 1 of each year, the healthcare provider shall submit an aggregate
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request for reimbursement representing all claims that meet the criteria under this section in the
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prior calendar year. The request for reimbursement shall include documentation of the attempt to
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collect on the claim(s), the name and identification number of the insured, the date of service, the
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unpaid co-payment, co-insurance, or deductible, the amount that was collected, if any, and the date
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and general method of contact with the insured. For the purposes of this section, an insured co-
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payment, co-insurance, and/or deductible amount due shall be determined based on the date that
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the service is rendered; provided, further, that a health insurer shall not prohibit reimbursement if
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the insured is no longer covered by the plan on the date that the request is made;
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(5) Nothing in this section shall prevent the health insurer from conducting an audit of the
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request for reimbursement of unpaid co-payment, co-insurance, and/or deductible amounts to verify
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that the insured was eligible for coverage at the time of service, that the service was a covered
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health benefit under the applicable health benefit plan, and to verify from the provider’s internal

LC006057 - Page 2 of 4
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log that reasonable efforts were made to contact the insured following the criteria outlined in this
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section. The health insurer must complete any such audit of the submitted report from the healthcare
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provider and notify the healthcare provider of any disputes as to the request for reimbursement
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within one hundred twenty (120) days of receipt of the request for reimbursement from the
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healthcare provider. The health insurer shall pay the healthcare provider sixty-five percent (65%)
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of the undisputed amounts as submitted by the healthcare provider in the request for reimbursement
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in accordance with this section within one hundred twenty (120) days of receipt of such requests
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from the healthcare provider. Any dispute regarding contested claims shall be subject to a dispute
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resolution process applicable to the arrangement between the health insurer and the healthcare
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provider; and
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(6) Any amounts attributable to co-payment, co-insurance, or deductible amounts collected
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by a healthcare provider after reimbursement has been made by the health insurer pursuant to this
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section shall be recorded by the healthcare provider and reported as an offset to future submissions
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to such health insurer.
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(c) No health insurer shall prohibit a healthcare provider from collecting the amount of the
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insured’s co-payment, co-insurance, and/or deductible, if any, at the time of service.
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(d) The health insurance commissioner shall promulgate regulations, by January 1, 2027,
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that are consistent with the rules developed by the Centers for Medicare & Medicaid Services for
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reasonable collection efforts required by a healthcare provider prior to submission of a request of
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reimbursement to a carrier. Notwithstanding the foregoing, in the event that the health insurance
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commissioner fails to promulgate such regulations, the provisions of this chapter shall be self-
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implementing, and carriers shall make applicable payments to healthcare providers in accordance
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with the provisions of this chapter, utilizing the same process adopted by the Centers for Medicare
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& Medicaid Services' reasonable collection efforts for bad debt, as documented in the most recent
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Medicare Provider Reimbursement Manual, CMS Pub. 15-1 and 15-2 (HIM-15) in effect, within
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ninety (90) days of the effective date of this chapter. The health insurance commissioner shall
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further require each carrier to provide the health insurance commissioner with an annual report
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showing the total number and amount of uncollected co-payments, co-insurances, and deductibles
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that are reimbursed as well as those that are denied. The report shall be made publicly available on
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the health insurance commissioner’s website.
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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 -- EQUITABLE FUNDING FOR HEALTHCARE PROVIDER
BAD DEBT
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This act would establish a procedure for a health insurer to reimburse a healthcare provider
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no less than sixty-five percent (65%) of each unpaid co-payment, co-insurance or deductible
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amount due, after reasonable collection efforts.
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This act would take effect upon passage.
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