Bill > S0168

This bill establishes a three-year pilot program requiring insurers in Rhode Island to eliminate prior authorization requirements for most services ordered by in-network primary care providers (PCPs). Specifically, the bill defines a "primary care provider" as doctors or advanced practice providers in family medicine, internal medicine, pediatrics, and obstetrics/gynecology, and defines "prior authorization" as a pre-service assessment an insurer requires before approving a healthcare service. The program will run from October 1, 2025, to October 1, 2028, with an important exception that prescription drugs will still require prior authorization. Insurers will be required to submit annual reports to state leadership detailing the program's implementation and impact. The bill tasks the Office of the Health Insurance Commissioner with ensuring insurers comply with the new requirements and establishing a workgroup to review and recommend improvements to the prior authorization process. The goal is to reduce administrative burdens on healthcare providers and potentially improve patient access to timely medical care by streamlining the authorization process for services ordered by primary care providers.

Health and Social Services

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