The bill amends Section 42-14.5-3 of the Rhode Island Health Care Reform Act of 2004, significantly enhancing the powers and responsibilities of the Office of the Health Insurance Commissioner (OHIC). Key provisions include the following:

1. The OHIC is granted the authority to undertake analyses, reports, studies, and recommendations regarding reimbursement and financing for the provision of primary care services to Rhode Island patients. This includes examining all sources of financing for primary care from various health insurance types, such as Medicaid, commercial insurance, and Medicare.

2. The OHIC will conduct primary care financing analyses to assess whether current payment methodologies support the necessary care delivery models for primary care, as defined in the 2021 National Academies of Sciences, Engineering, and Medicine report.

3. The OHIC is required to publish and submit a report to the General Assembly by July 1, 2026, and every two years thereafter, outlining current financing structures and reimbursement rates for Rhode Island primary care providers. This report will include detailed information on the scope of the analysis, definitions of primary care services, and sufficient data for comparisons across various factors affecting reimbursement rates.

4. Additionally, the OHIC must publish and submit a report by September 1, 2026, and every two years thereafter, making and justifying recommendations for adjustments to primary care reimbursement and financing. This includes investigating access to care, quality of care, and other relevant factors.

5. The bill mandates that state government departments involved in Medicaid financing include recommended rates in their annual budget submissions, along with explanations for any variances.

6. The OHIC will use its analyses and recommendations to inform existing regulatory activities related to commercial insurance reimbursement and may consider self-insured commercial insurance within its scope.

7. The OHIC will also seek to influence Medicare reimbursement policies based on its analyses and recommendations.

8. To support this work, a nine-member advisory committee will be established, appointed by the governor, including representatives from various sectors, such as large and small primary care providers, hospitals, community health centers, Medicaid Managed Care Organizations, and patient care advocacy groups. The proceedings of this advisory committee will be subject to open meetings laws.

The act will take effect immediately upon passage.

Statutes affected:
6119: 42-14.5-3