The bill amends Section 35-17-1 and Section 42-14.5-3 of the General Laws to improve financial planning for medical assistance and enhance transparency in health insurance practices. It requires the department of human services and the department of behavioral healthcare, developmental disabilities, and hospitals to provide monthly data to caseload estimating conferences, including forecasted costs from biennial rate reviews. The bill also mandates that the health insurance commissioner conduct quarterly public meetings to discuss insurer rates and operations, and establishes a consumer/business/labor/medical advisory council to address health insurance concerns. Additionally, a subcommittee is to be formed to focus on provider-health plan relationships, and a task force will analyze the impact of merging individual and small-employer health insurance markets. The bill includes insertions of new legal language but does not specify deletions.

The bill also calls for the creation of a workgroup to streamline healthcare administration, which will include representatives from various healthcare sectors and organizations. This workgroup is tasked with developing recommendations on electronic eligibility verification, claims processing uniformity, and prior authorization requirements, with a report due to the general assembly by June 30, 2024. The bill emphasizes the need for annual review of medical services and prescription drugs requiring prior authorization and aims to improve communication between health plans, providers, and patients. It includes provisions to protect payors' ability to use temporary code edits for fraud detection and does not alter existing rights or obligations related to fraudulent billing activities. The bill also requires the OHIC to report on various healthcare-related topics and mandates assessments and reports on social and human service programs, with a comprehensive review process to be established by September 1, 2023. The governor is required to appropriate recommended rates in the annual budget, and the general assembly is tasked with appropriating funding for the analyses, reports, and studies. The act will take effect upon passage.

Statutes affected:
7591: 35-17-1, 42-14.5-3