The "Rhode Island Prior Authorization Reform Act of 2025" amends the existing "Benefit Determination and Utilization Review Act" by establishing a three-year pilot program that prohibits insurers from imposing prior authorization requirements for any admission, item, service, treatment, or procedure ordered by an in-network primary care provider, with the exception of prescription drugs. This initiative aims to streamline access to medical treatments and reduce administrative burdens on providers and patients. Insurers are required to submit annual reports on the program's implementation and outcomes, which will expire on October 1, 2028, unless extended by the General Assembly.

The bill also updates definitions within the law, clarifying terms related to healthcare services and delineating the roles of various stakeholders, including insurers and primary care providers. Additionally, it enhances the powers and duties of the health insurance commissioner to ensure that insurers minimize administrative burdens that may delay medically necessary care. The commissioner is tasked with promulgating rules and regulations to implement the provisions of the pilot program and convening a payor/provider workgroup to review and make recommendations regarding the improvement and simplification of prior authorization processes.

The act is set to take effect on October 1, 2025.

Statutes affected:
5120: 27-18.9-2, 42-7.2-5, 42-14.5-3
5120  SUB A: 27-18.9-2, 42-7.2-5, 42-14.5-3