The bill amends the Rhode Island Health Care Reform Act of 2004 by introducing a new definition for "primary care services," which refers to professional services rendered by primary care providers at a primary care site of care. It clarifies the powers and duties of the health insurance commissioner, including the requirement that all biennial reports conducted by the commissioner shall include a review and recommendations of rates for primary care services starting September 1, 2025.

The bill emphasizes accountability standards for social and human service providers and promotes transparency and public reporting. It establishes a framework for the health insurance commissioner to conduct public meetings, make recommendations to the governor and legislative finance committees, and create an advisory council to address concerns from consumers, businesses, and medical providers regarding health insurance.

Additionally, the bill mandates the formation of a workgroup to streamline healthcare administration processes, focusing on electronic eligibility verification, claims processing, and prior authorization requirements. It enhances oversight and regulation of health insurance by establishing selective prior authorization programs for providers in risk-based payment contracts and requiring annual reviews of medical services and prescription drugs that need prior authorization. The bill also emphasizes continuity of care during treatment transitions and encourages the use of electronic prior authorization technology.

The act will take effect upon passage.