The "Rhode Island Prior Authorization Reform Act of 2025" establishes 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 services and reduce administrative burdens on providers and patients. Insurers will be required to submit annual reports on the program's implementation to the governor, the speaker of the house of representatives, the president of the senate, and the office of the health insurance commissioner. The program is set to expire on October 1, 2028, unless extended by the General Assembly.

The bill also updates definitions related to "insurer," "primary care provider," and "prior authorization" to clarify the roles of stakeholders in the healthcare system while maintaining the integrity of fraud investigations and appeals. Additionally, the Office of the Health Insurance Commissioner is tasked with ensuring that insurers minimize administrative burdens that may delay medically necessary care. A standing advisory steering committee will be formed to review and make recommendations regarding the continuous improvement and simplification of prior authorization processes, assess the impact on access to primary care services, and submit annual recommendations to the General Assembly.

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

Statutes affected:
168: 27-18.9-2, 42-7.2-5, 42-14.5-3
168  SUB A: 27-18.9-2, 42-7.2-5, 42-14.5-3
168  SUB B: 27-18.9-2, 42-7.2-5, 42-14.5-3