Rhode Island House Bill H8327

Rhode Island 2026 Regular Session

• Introduced: 3/20/26
• Refer: 3/20/26

Caption

RELATING TO INSURANCE -- PRIMARY CARE ADMINISTRATIVE FAIRNESS ACT

Summary

H8327 creates the “Primary Care Administrative Fairness Act” within Rhode Island’s insurance laws. The bill would prohibit payers from requiring primary care providers to perform uncompensated referral coordination tasks, such as preparing documentation, obtaining prior authorizations, communicating with specialists or insurers, tracking approvals, and transmitting materials. It also requires payers to choose one of two approaches for primary care-initiated referrals: either eliminate prior authorization requirements for those referrals, or reimburse primary care practices separately for the reasonable attributable costs of referral coordination services. The bill further addresses laboratory claim handling and coding practices. If a lab service is covered under any ICD-10 code recognized by the payer, coverage could not be denied solely because the ordering physician used a different diagnostic code. Payers would also be barred from requiring resubmission, code changes, or additional justification merely to satisfy internal coding preferences when the service is otherwise covered. Any contract term that conflicts with these requirements would be void and unenforceable.

Impact

If enacted, the bill would add a new chapter to Title 27 of the Rhode Island General Laws and impose new duties on health insurers, HMOs, managed care organizations, and Medicare Advantage plans operating in the state. It would shift some administrative burden and cost from primary care practices to payers by either eliminating prior authorization for primary care referrals or requiring separate reimbursement for referral coordination. The Office of the Health Insurance Commissioner would be responsible for enforcement, reviewing payer policies, requiring provider agreement updates by January 1, 2027, and publishing annual reports beginning in 2028 on referral volumes, reimbursement for referral coordination, and lab claim denial rates.

Sentiment

Based on the bill text and the absence of recorded committee testimony or votes, the overall sentiment appears supportive of reducing administrative burden on primary care practices and improving payment fairness. The bill’s framing suggests a policy goal of streamlining referrals, limiting insurer paperwork demands, and reducing claim denials tied to coding technicalities. No opposing arguments or recorded vote history are available in the provided materials.

Contention

The main points of potential contention are the bill’s cost and operational impact on payers versus its intended relief for primary care providers. Insurers and managed care organizations may object to being required either to remove prior authorization for referrals or to pay separately for coordination work, as well as to limits on their coding and claims review practices. Primary care advocates would likely support the measure because it seeks compensation for administrative tasks that are often unpaid and reduces friction in referrals and lab coverage decisions. No specific stakeholder testimony is provided, so these concerns are inferred from the bill’s structure rather than from recorded debate.