The bill amends Section 42-14.5-3 of the Rhode Island Health Care Reform Act of 2004, enhancing the powers and duties of the Office of the Health Insurance Commissioner (OHIC). Key provisions include the requirement for population-based contracts to include a budget agreement for each contract year, with review and prior approval by the OHIC if any annual increase in the total cost of care for services reimbursed under the contract, after risk adjustment, exceeds the Consumer Price Index for all Urban Consumers (CPI-U) percentage increase, plus three and one-half percent (3.5%) from October 1, 2025, to September 30, 2028.

Additionally, the bill mandates that hospital contracts include a provision agreeing on rates for each contract year, with review and prior approval by the OHIC required if the average rate increase, including estimated quality incentive payments, is greater than the CPI-U percentage increase, plus three percent (3%) from October 1, 2025, to September 30, 2028.

The bill also emphasizes the ongoing work of the administrative simplification task force and mandates annual reports on various healthcare-related topics, ensuring that healthcare services remain affordable and accessible while promoting transparency and accountability in the healthcare system.

Statutes affected:
681: 42-14.5-3