Bill > H6317

This bill prohibits insurers in Rhode Island from requiring prior authorization for most medical services and prescription drugs ordered by primary care providers (PCPs), which include internal medicine physicians, family medicine physicians, pediatricians, geriatricians, OB-GYNs, nurse practitioners, certified nurse midwives, and physician's assistants. The bill allows exceptions for controlled substances and for individual PCPs with documented cases of fraud, waste, or abuse. Additionally, the bill mandates that starting January 1, 2026, insurers must use a standardized, two-page prior authorization form that can be submitted electronically and is available through an online portal. The form must be filed with the Office of the Health Insurance Commissioner, and the office is authorized to develop further rules to reduce administrative burdens on healthcare providers. The legislation aims to streamline the healthcare authorization process, potentially reducing delays in patient care and administrative obstacles for primary care providers. By creating a uniform process and limiting prior authorization requirements, the bill seeks to make healthcare more accessible and efficient for patients and providers alike.

Health and Social Services

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