Bill > H5120

This bill introduces the "Rhode Island Prior Authorization Reform Act of 2025", which establishes a three-year pilot program that prevents health insurers from requiring prior authorization for most medical services ordered by primary care providers (PCPs). Specifically, the bill prohibits insurers from mandating pre-service assessments or approvals for any admission, item, service, treatment, or procedure ordered by an in-network PCP, with the exception of prescription drugs. The bill defines primary care providers as physicians, nurse practitioners, and physician assistants in specialties like family medicine, internal medicine, pediatrics, and obstetrics/gynecology. Insurers will be required to submit annual reports to state leadership detailing the program's implementation and impacts. The pilot program is set to run from October 1, 2025, to October 1, 2028, and aims to reduce administrative burdens that can delay patient care. The Office of the Health Insurance Commissioner will be responsible for monitoring the program, convening a workgroup to review its progress, and making recommendations to improve prior authorization processes. Unless the general assembly specifically votes to continue the program, it will automatically expire at the end of the three-year period.

Health and Social Services

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