The bill amends the Rhode Island Health Care Reform Act of 2004 to enhance accountability and oversight within the state's health care system. It introduces a new definition of "primary care services," which refers to professional services rendered by primary care providers at a primary care site of care. The bill outlines the powers and duties of the health insurance commissioner, including conducting public meetings, making recommendations to the governor and legislative finance committees, and forming advisory councils to address consumer and provider concerns regarding health insurance.

Additionally, the bill mandates the creation of a workgroup to streamline healthcare administration processes and develop guidelines for electronic eligibility verification and claims processing. It focuses on improving the oversight and management of health insurance, particularly concerning prior authorization processes and the integration of behavioral health care. The bill establishes selective prior authorization programs for healthcare providers in risk-based payment contracts, mandates annual reviews of medical services and prescription drugs requiring prior authorization, and emphasizes improved communication among health plans, providers, and patients.

Furthermore, the bill requires that all biennial reports include a review and recommendations of rates for primary care services starting September 1, 2025, ensuring reimbursement rates align with federal and state standards. Overall, the act aims to enhance transparency, efficiency, and fairness in the health insurance market, benefiting both consumers and providers.