The bill amends the Rhode Island Health Care Reform Act of 2004 to enhance the powers and duties of the health insurance commissioner. It specifically requires the 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. The uncompensated care adjustment will be calculated separately from any base rate cap and will increase the allowable reimbursement rate or rate increase above the base rate cap, without modifying the underlying rate cap methodology.

The commissioner is also tasked with adopting rules and regulations to establish a transparent formula-based method for calculating the statewide hospital uncompensated care adjustment, which 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 be updated annually.

Additionally, the bill emphasizes the work of the administrative simplification task force to improve the prior authorization process and outlines the responsibilities of the office in monitoring healthcare services, ensuring compliance with mental health provisions, and enhancing access to care in Rhode Island.

Statutes affected:
3091: 42-14.5-3