Rhode Island House Bill H7942

Rhode Island 2026 Regular Session

• Introduced: 2/27/26
• Refer: 2/27/26

Caption

Requires insurance companies to prove that a healthcare service or procedure is not medically necessary.

Impact

The introduction of H7942 is expected to have significant implications on state laws governing insurance practices and patient rights. By requiring insurers to prove that a healthcare service is not medically necessary, the bill aims to protect patients from arbitrary denials of care. This change is intended to enhance consumer protections within the insurance landscape and increase access to necessary healthcare services. Proponents of the bill argue that it will encourage better patient outcomes by ensuring that necessary treatments are not denied without proper justification.

Summary

House Bill 7942, introduced by Representative Joseph J. Solomon, addresses the Benefit Determination and Utilization Review Act, which governs how healthcare services are determined to be medically necessary by insurance companies. The crux of the bill is to shift the burden of proof regarding the medical necessity of a treatment or procedure from the patient to the insurance provider. If enacted, this legislation will create a legal presumption that any healthcare service authorized by a provider for a patient is medically necessary, thereby requiring insurers to justify any denial for coverage of such services.

Contention

There may be points of contention surrounding H7942, particularly regarding its potential impact on insurance companies and the broader healthcare system. Supporters believe that the bill champions patient rights and accountability within the insurance industry. However, opponents might argue that the bill could lead to increased costs for insurers and, ultimately, for consumers, as insurers may need to implement more rigorous reviews of treatments. Additionally, there are concerns about how this bill may interact with existing laws and regulations, as well as the potential for increased litigation as patients and insurers navigate the new requirements.