Requires each healthcare entity/network plan to compile/report to health insurance commissioner a summary of how the healthcare entity/network plan requires its contracted providers to submit claims for in-network outpatient behavioral health services.
Summary
H5863 amends Rhode Island’s Health Care Accessibility and Quality Assurance Act to impose new reporting and contracting requirements on healthcare entities and network plans for in-network outpatient behavioral health services, including substance use disorder services. By January 1, 2026, and at least annually thereafter, each entity or plan must compile and report to the health insurance commissioner a summary of how contracted providers are required to submit claims for these services, including any required CPT codes, modifiers, or other formal claim-identification requirements.
The bill also requires that every contract for in-network outpatient behavioral health services, or outpatient diagnostic or therapeutic services billed with a behavioral health modifier, include a provision that rates paid under the contract will receive a one-time average increase effective January 1, 2026. That increase must be at least the CPI-U All Items Less Food and Energy inflation percentage, as determined by the commissioner by October 1, 2025, plus an additional five percent. The act takes effect upon passage.
Impact
The bill would add a new section to chapter 27-18.8 of the Rhode Island General Laws and would directly affect healthcare entities, network plans, and contracted behavioral health providers. It creates a new reporting obligation to the health insurance commissioner and would require contract language guaranteeing a specified rate increase for certain outpatient behavioral health and substance use disorder services. The measure is intended to affect reimbursement practices and claim-submission rules in the commercial insurance market for behavioral health care.
Sentiment
Based on the bill text and the limited available context, the measure appears to be framed as a provider reimbursement and behavioral health access initiative, with an emphasis on improving payment levels and transparency in claims processing. No committee transcript or recorded votes were provided, so there is no documented public debate or formal vote history to indicate broader support or opposition. The overall tone of the proposal suggests a policy effort to strengthen behavioral health networks and address payment adequacy.
Contention
The main likely point of contention is the mandated rate increase, which would require insurers and network plans to raise payments for covered behavioral health services by an inflation-based amount plus five percent. Insurers and network plans may view this as a cost increase and a contractual mandate, while behavioral health providers and advocates are likely to support it as a reimbursement and access measure. A secondary issue is the administrative burden of annual reporting and the need to track claim-submission requirements by CPT code, modifier, or other formal billing rules.