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HB 8267

AN ACT RELATING TO INSURANCE -- EQUITABLE FUNDING FOR HEALTHCARE PROVIDER BAD DEBT

2026 Regular Session Introduced by Sam Azzinaro and 9 co-sponsors

Rhode Island will require insurers to reimburse providers at least 65% of unpaid patient cost-sharing (co-pays, deductibles, co-insurance) after reasonable collection efforts.

04/14/2026 Committee recommended measure be held for further study
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Bill Summary · HB 8267

Summary of HB 8267 (Rhode Island, 2026)

Title

AN ACT RELATING TO INSURANCE -- EQUITABLE FUNDING FOR HEALTHCARE PROVIDER BAD DEBT

Purpose and Intent

  • Establish a framework for reimbursing healthcare providers for unpaid patient cost-sharing (co-payments, co-insurance, and deductibles) that remain after reasonable collection efforts.
  • Create a minimum reimbursement floor to reduce the financial impact on providers from patient bad debt, ensuring providers recover a portion of unpaid amounts from insurers.

Key Provisions

Definitions

  • Clarifies terms used in this chapter:
    • Co-insurance: percentage of the allowed amount after any co-payment.
    • Co-payment: fixed dollar amount owed by the insured for services.
    • Deductible: initial amount the insured must pay before the insurer pays.
    • Health insurance commissioner: as defined by state law.

Reimbursement Obligation

  • Health insurers must reimburse healthcare providers no less than 65% of each unpaid co-payment, co-insurance, and/or deductible amount after reasonable collection efforts.
  • Unpaid amounts considered for reimbursement are those that remain after efforts to collect.

Reimbursement Process and Criteria (Eligibility)

  • Eligible claims:
    • Derived from wholly or partly unpaid co-payment, co-insurance, or deductible.
    • Each claim must be at least $250 and correspond to a unique covered service per insured.
  • Collection Efforts:
    • Providers must show reasonable collection efforts over up to 120 days from the first bill, including documentation of partial or non-payment and contact attempts (date, method).
  • Annual Aggregate Request:
    • By May 1 each year, providers file an aggregate reimbursement request for the prior calendar year.
    • Must include: collection attempts, insured’s name/ID, date of service, unpaid amount, amount collected (if any), and contact details.
    • The insured’s coverage status at the time of service matters for eligibility; coverage gaps at the time of the request do not automatically bar reimbursement.
  • Audit Rights:
    • Insurers may audit reimbursement requests to verify eligibility (coverage at the time of service, covered benefits, and provider’s collection records).
    • Insurer must resolve disputes within 120 days of receipt of the request.
    • Insurer must pay 65% of undisputed amounts within 120 days after resolution.
    • Contested claims follow the applicable dispute resolution process.

Offsets and Post-Reimbursement Collections

  • Any amounts collected after the insurer’s reimbursement must be recorded by the provider and offset against future submissions to that insurer.

Prohibitions and Regulatory Framework

  • Insurers may not prohibit collection of the insured’s co-payment, co-insurance, and/or deductible at the time of service.
  • The Health Insurance Commissioner must issue regulations by January 1, 2027 aligning with CMS (Centers for Medicare & Medicaid Services) reasonable collection efforts for bad debt.
  • If the Commissioner does not promulgate regulations, the act is self-implementing and carriers must follow CMS HIM-15 guidelines within 90 days of the act’s effective date.
  • Annual public reporting: Carriers must provide the Commissioner with yearly data on total uncollected amounts reimbursed and denied; the report will be publicly available.

Affected Parties

  • Healthcare providers: eligible to receive 65% reimbursement on certain unpaid patient cost-sharing.
  • Health insurers/carriers: subject to new reimbursement obligations, audits, and reporting requirements.
  • Patients/insured individuals: subject to standard cost-sharing in coverage; impact is primarily through the insurer’s reimbursement framework to providers.
  • Rhode Island Health Insurance Commissioner: regulator of the new framework and enactor of implementing regulations; also responsible for annual reporting.

Timeline and Effective Date

  • Effective date: Upon passage of the act.
  • Regulatory timeline: Regulations to align with CMS by January 1, 2027. If not enacted, the act becomes self-implementing with CMS-based implementation within 90 days of passage.
  • Annual reporting: Providers must submit aggregate reimbursement requests by May 1 each year for the prior year.

Practical Implications

  • Providers could recover at least 65% of eligible unpaid patient cost-sharing, reducing bad debt write-offs.
  • Insurers gain a defined process for review, audit, and dispute resolution of reimbursement requests.
  • Increased transparency through public reporting of reimbursement and denial data.

Administrative Notes

  • The bill was introduced March 11, 2026, and referred to House Health & Human Services.
  • Sponsorship includes multiple representatives; co-sponsors listed.
  • Committee recommended holding the bill for further study in April 2026.

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

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