Bill > S0053

This bill provides that an insurer would not be allowed to impose prior authorization requirements for any admission, item, service, treatment, or procedure ordered by an in-network primary care provider (PCP), with one key exception: the prohibition does not apply to prescription drugs. The bill defines a primary care provider broadly to include general internists, family physicians, pediatricians, geriatricians, OB-GYNs, nurse practitioners, physician's assistants, and other healthcare providers licensed to provide primary care. Prior authorization is defined as the approval a PCP must obtain from an insurer before healthcare is covered for a patient. The bill amends existing Rhode Island laws to add this provision, specifically updating definitions in the state's healthcare insurance regulations and giving the Health Insurance Commissioner authority to enforce these new restrictions. The bill is part of the "Rhode Island Prior Authorization Reform Act of 2025" and is set to take effect on July 1, 2026, with the goal of reducing administrative burdens that may delay medically necessary care for patients.

Health and Social Services

https://status.rilegislature.gov/