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HB 6317

AN ACT RELATING TO INSURANCE -- BENEFIT DETERMINATION AND UTILIZATION ACT

2025 Regular Session Introduced by Mia Ackerman and 5 co-sponsors

Rhode Island bill establishing or modifying insurance benefit determination and utilization review procedures affecting coverage decisions and patient healthcare access.

05/09/2025 Introduced, referred to House Health & Human Services
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WeVote Research Nonpartisan
Bill Summary · HB 6317

Legislative bill overview

HB 6317 relates to insurance benefit determination and utilization procedures in Rhode Island. The bill appears to establish or modify rules governing how insurance companies determine coverage eligibility and authorize medical services. Without access to the full text, the specific provisions regarding benefit determination timelines, appeals processes, or utilization review standards cannot be detailed.

Why is this important

Insurance benefit determination directly affects patients' access to healthcare and their out-of-pocket costs. Utilization review processes determine which treatments insurers will cover, making procedural rules consequential for both patient care and insurance company operations. Clear standards in this area protect consumers from arbitrary denials while balancing insurer concerns about unnecessary procedures.

Potential points of contention

  • Prior authorization requirements — Disputes typically arise over whether insurers should require pre-approval for treatments, with patients/providers viewing this as burdensome delays versus insurers viewing it as cost control
  • Appeals and review timelines — Disagreement over how quickly insurers must respond to coverage denials and whether expedited reviews should be available for urgent care situations
  • Transparency standards — Tension between requiring detailed explanations for benefit denials (consumer protection) and administrative burden on insurers

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

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