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HB 7002

AN ACT RELATING TO BUSINESSES AND PROFESSIONS -- BOARD OF MEDICAL LICENSURE AND DISCIPLINE

2026 Regular Session Introduced by Sam Azzinaro and 3 co-sponsors

Rhode Island HB7002 requires health plans to promptly pay claims and bans denial solely for third-party claim status, boosting timely reimbursements and imposing late-payment inter

06/22/2026 Signed by Governor
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WeVote Research Nonpartisan
Bill Summary · HB 7002

Overview

  • Jurisdiction: Rhode Island
  • Bill: HB 7002 (2026)
  • Title: AN ACT RELATING TO BUSINESSES AND PROFESSIONS -- BOARD OF MEDICAL LICENSURE AND DISCIPLINE
  • Purpose: Prohibit denial of payment for medical bills based solely on third-party claim status and adjust related prompt-payment provisions across multiple health-plan types. The bill also broadens the definition of unprofessional conduct for medical licensure and discipline, but the core payment provisions are the primary actionable changes.

What the bill does

Main purpose and intent

  • Ensure that health plans and healthcare entities do not deny or delay payment of medical bills solely because the claim originates from a third-party (other than workers’ compensation).
  • Align prompt-payment requirements across several health-plan types to improve timely reimbursement to providers and policyholders.

Key provisions and changes

1) Unprofessional conduct (Board of Medical Licensure and Discipline)
- The bill expands or reiterates the scope of unprofessional conduct, enumerating numerous grounds for discipline (e.g., fraud, misrepresentation, prescribing practices, patient abuse, billing misconduct, sexual misconduct, failure to maintain records, malpractice patterns, etc.).
- The list provides explicit items that the board may use to define unprofessional conduct, subject to regulations with prior director approval.

2) Prompt processing of claims (general health plans)
- Applies to various health-plan categories:
- Accident and Sickness Insurance Policies (27-18-61)
- Nonprofit Hospital Service Corporations (27-19-52)
- Nonprofit Medical Service Corporations (27-20-47)
- Health Maintenance Organizations (27-41-64)
- Key timing standards:
- Fully processed payments: within 40 calendar days for written claims; within 30 calendar days for electronic claims.
- Denials/pendings: must provide written reasons within 30 days and indicate any additional information required; no unreasonable limits on submitting additional information.
- Interest for late payment: 12% per year, accruing from day 31 (electronic) or day 41 (written) after receipt of a complete claim, until payment is issued.
- Coverage and exceptions:
- Claims cannot be denied simply because of third-party or incident-related issues (except workers’ comp).
- Several carve-outs for: court/agency directives, liquidation/rehabilitation, matters beyond control, fraud investigations, and claims submitted or resubmitted outside specified windows (with 90-day grace limits), plus an option for director-determined substantial compliance exemptions.
- Substantial compliance defined as processing and paying 95% of claims within the established timeframes.
- Contracts with providers cannot conflict with these requirements (such conflicting provisions are void).

Who would be affected

  • Healthcare providers and policyholders who submit claims to health plans and managed care entities (insurance companies, nonprofit service organizations, HMOs).
  • Health plans, insurers, and health-care entities operating in Rhode Island, including:
    • Accident and Sickness insurers
    • Nonprofit Hospital Service Corporations
    • Nonprofit Medical Service Corporations
    • Health Maintenance Organizations
  • Medical professionals regulated by the Board of Medical Licensure and Discipline (through the unprofessional conduct provisions).

Procedural and timeline aspects

  • Effective date: This act takes effect upon passage.
  • Legislative process: Introduced January 7, 2026; referred to House Corporations; subsequently advanced through committee and floor actions with a noted schedule for consideration in June 2026.
  • Implementation considerations: Health plans would need to define “complete claim” standards and adjust claims-processing systems to meet the 40/30-day timelines and 95% substantial-compliance benchmark.

Practical impact

  • Potential improvement in payment timeliness and reduced payment disputes between providers and payers.
  • Providers would have clearer recourse for interest on late payments.
  • Patients may experience fewer disruptions in care financing due to timely insurer payments.
  • Expanded board authority to discipline behaviors related to billing, advertising, records, and professional conduct.

If you would like, I can provide a side-by-side comparison with current Rhode Island law and a brief impact assessment for specific stakeholder groups (e.g., independent physicians, hospital systems, or patient advocacy groups).

Compiled from official sources — confirm details with the bill’s official record.

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