The bill amends Section 27-18.9-5 of the General Laws to introduce new procedural requirements for insurers concerning benefit determinations and utilization reviews. It specifically addresses step therapy protocols, allowing healthcare professionals to request exceptions for immediate coverage of prescribed treatments under certain conditions, such as when a step is contraindicated, ineffective, or would delay necessary care. Insurers are required to create a clear process for submitting exception requests, respond within specified timeframes, and ensure that individuals reviewing these requests are qualified healthcare professionals. The determinations made regarding these exceptions are valid for up to one year.

Additionally, the bill amends Section 42-14.5-3 to enhance the powers and duties of the office of health insurance commissioner, granting oversight and enforcement authority over the new requirements established in Section 27-18.9-5. This includes the ability to require disclosure of information, simplify appeals procedures, and impose penalties for noncompliance. The bill aims to improve the management of step therapy protocols and ensure that medically necessary care is delivered without undue delay. The act will take effect upon passage.

Statutes affected:
5119: 27-18.9-5, 42-14.5-3