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 treatments and reduce administrative burdens on healthcare providers and patients. Insurers are required to submit annual reports on the program's implementation, which 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 roles and responsibilities within the healthcare system. Additionally, the Office of the Health Insurance Commissioner (OHIC) is tasked with ensuring that insurers minimize administrative burdens that may delay medically necessary care and is required to convene a workgroup to review and make recommendations regarding the improvement of prior authorization processes. The workgroup will focus on continuous improvement, communication, and collaboration related to prior authorizations, as well as the assessment of access to primary care services and quality care measures during the pilot program.

The legislation emphasizes the importance of reporting and collaboration among state agencies to enhance the efficiency and transparency of healthcare delivery and insurance processes in Rhode Island.

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