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HB 8309

AN ACT RELATING TO INSURANCE -- FEE SCHEDULE TRANSPARENCY AND FAIR BILLING ACT

2026 Regular Session Introduced by Megan Cotter and 7 co-sponsors

Insurers must publish and update maximum reimbursements for all covered services, and reimburse claims at or below those published rates to ensure fair, transparent billing.

04/14/2026 Committee recommended measure be held for further study
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Bill Summary · HB 8309

Summary of HB 8309 (Rhode Island, 2026) – Fee Schedule Transparency and Fair Billing Act

Purpose and intent

  • Establishes a new chapter (Chapter 84) within Rhode Island’s Insurance Title to promote transparency in insurer fee schedules and ensure fair billing practices.
  • Aims to require insurers to publish and share with physicians and medical service providers the maximum allowable reimbursement (fee schedules) for all covered services and procedure codes.
  • Seeks to reduce disputes over reimbursement by ensuring providers know in advance the payment limits and by validating reimbursements against published maximums.

Key provisions

1) Publication of fee schedules

  • Insurers must publish a complete, current fee schedule listing the maximum allowable reimbursement for every covered service and procedure code.
  • The obligation applies to all entities providing medical services, including:
    • Physicians
    • Physician practices
    • Physician corporations
    • Physician partnerships
    • Other entities providing medical services
  • Providers must be supplied with the fee schedule via secure provider portals.
  • Updates to the fee schedules must be provided within 30 days of any change.

2) Fair reimbursement standard

  • Insurers must reimburse any covered claim at or below the published maximum allowable rate in full.
  • Insurers may not reduce payments, apply inflated “usual and customary” charges, or impose penalties solely because the billed amount exceeds the provider’s charge, so long as that amount does not exceed the published maximum.

3) Definitions

  • The term “insurer” includes:
    • Nonprofit medical service corporations
    • Hospital service corporations
    • Health maintenance organizations (HMOs)
    • Other insurers offering health services
    • Any entity defined as an insurer under Rhode Island law (specifically § 42-62-4)

4) Enforcement and reporting

  • The Rhode Island Office of the Health Insurance Commissioner (OHIC) enforces compliance.
  • Penalties can be up to $25,000 per violation.
  • OHIC must publish annual reports (by July 1 each year) detailing fee schedule availability and billing disputes.

Affected entities

  • Insurers: All health service, nonprofit medical service, and HMO-type insurers, plus any entity defined as an insurer under state law.
  • Healthcare providers: Physicians and any physician groups, practices, corporations, or partnerships that render covered medical services.
  • Patients: Indirectly affected through more predictable reimbursement and transparency in billing.

Timeline and effective date

  • Effective date: 90 days after passage.
  • Ongoing requirements:
    • Insurers must maintain and update fee schedules, distributing updates within 30 days of changes.
    • OHIC annual reporting on fee schedules and billing disputes, finalized by July 1 each year.

Procedural status

  • Introduced: March 18, 2026
  • Referred to: House Corporations
  • Action history:
    • Hearing/consideration scheduled (April 10, 2026)
    • Committee recommended holding the measure for further study (April 14, 2026)

Practical impact

  • Providers will have advance knowledge of reimbursement limits, potentially reducing billing disputes and speedier payer decisions for covered services.
  • Insurers face stricter oversight and potential penalties for noncompliance, encouraging consistent publication and updates of fee schedules.
  • The act could influence payer-provider negotiations by clarifying maximum reimbursement frameworks and curbing blanket reductions based on charged amounts.

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

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