The bill amends the Rhode Island Health Care Reform Act of 2004 to enhance the powers and responsibilities of the health insurance commissioner. Key provisions include the requirement for the office of the health insurance commissioner to incorporate uncompensated care as a formula-driven numeric adjustment in the methodology used to establish any affordability standard or rate cap applicable to hospital contracts, effective January 1, 2027. This adjustment will be applied as an additive adjustment to any rate cap or affordability standard methodology that was in effect as of January 1, 2026, and will be calculated separately from any base rate cap, including those derived from the Consumer Price Index (CPI), medical inflation, economic growth, or other cost containment measures. The adjustment will increase the allowable reimbursement rate or rate increase above the base rate cap and will not modify the underlying rate cap methodology in effect as of January 1, 2026.

Additionally, the commissioner is tasked with adopting rules and regulations to establish a transparent formula-based method for calculating the statewide hospital uncompensated care adjustment. This method will define hospital uncompensated care, convert the statewide uncompensated care burden into a single percentage adjustment applied uniformly above the base rate cap for all hospital contracts, and will be updated annually.

The bill also emphasizes the need for improved healthcare delivery and equitable coverage for behavioral health care, although specific provisions related to analyses and reports on health insurance coverage, mental health parity, and the adequacy of health plans are not detailed in the provided text.

Statutes affected:
7875: 42-14.5-3