The "Rhode Island Prior Authorization Reform Act of 2025" seeks to amend existing healthcare laws to improve access to necessary services and streamline the prior authorization process. A significant provision of the bill 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 change aims to reduce administrative burdens on healthcare providers and enhance patient access to care.

The bill introduces new definitions related to insurers, primary care providers, and prior authorization. It also outlines the responsibilities of the Secretary of the Executive Office of Health and Human Services (EOHHS) in coordinating state-administered health services, particularly Medicaid. The Secretary is tasked with ensuring that insurers minimize administrative burdens that may delay medically necessary care, including by implementing the provisions of the bill.

Additionally, the bill mandates that insurers disclose adjudication decisions on claims denied due to temporary code edits for fraud detection. It emphasizes the need for collaboration among various departments to improve service delivery and accountability, while promoting transparency in administrative costs. The bill includes provisions for a common website for providers to access preauthorization information and guidelines for maintaining continuity of care. The effective date of the bill is July 1, 2026.

Statutes affected:
53: 27-18.9-2, 42-7.2-5, 42-14.5-3