This bill amends Section 42-14.5-3 of the Rhode Island General Laws to expand the duties of the health insurance commissioner. The commissioner is now required to hold quarterly public meetings to discuss health insurers' rates, services, and operations, and their impact on stakeholders. The commissioner must also make recommendations on healthcare insurance regulations to the governor and finance committees, prepare or comment on draft legislation, and establish an advisory council to develop proposals for affordable small business health insurance. The council is tasked with creating a complaint process for small businesses and assessing the health provider community's views on insurance reimbursement. The commissioner will enforce provisions of titles 27 and 42, analyze the reinsurance fund, and study the impact of changes to the health insurance markets. The bill includes new legal language and does not indicate any deletions from current law.

The bill also requires a comprehensive analysis of the potential merger of the individual and small-group health insurance markets, examining its effects on premiums, market stability, and consumer choice. A task force, including representatives from various sectors, will assist the commissioner, who may also contract outside expertise. The findings will be reported to the house and senate finance committees. A workgroup is to be established to streamline healthcare administration, with recommendations on standards for electronic eligibility verification, claims processing, and fraud detection. The workgroup must comply with the commissioner's requests for information and has enforcement authority to implement this section. Reports are due by June 30, 2024, and on prescription drug prior authorizations by January 1, 2025. The bill also mandates health plans to review medical services and prescription drugs requiring prior authorization annually, share changes on provider-accessible websites, and ensure transparency and timely notification of determinations. It emphasizes continuity of patient care, encourages electronic prior authorization technology, and includes provisions for reporting on various healthcare aspects. The Office of the Health Insurance Commissioner is also tasked with reviewing all social and human service programs contracted with or licensed by the state, establishing baselines for eligibility and reimbursement rates, and creating a model for future studies. The bill sets a timeline for assessments and reports to be completed by specific dates in 2023 and requires a biennial assessment and review process for rate adjustments. Departments must include components of the assessment in their annual budget submissions starting October 1, 2023, and the General Assembly is responsible for appropriating necessary funding. The act takes effect upon passage.

Statutes affected:
7623: 42-14.5-3