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 office of 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 within the Benefit Determination and Utilization Review Act to clarify the roles of various stakeholders in the healthcare system, including definitions for "insurer," "primary care provider," and "prior authorization." Additionally, it enhances the responsibilities of the health insurance commissioner, requiring the commissioner to ensure that insurers minimize administrative burdens that may delay medically necessary care. The commissioner is also tasked with convening a workgroup to review and make recommendations regarding the improvement and simplification of prior authorization processes, as well as assessing the impact of the pilot program on access to primary care services and other quality care measures.

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