This bill amends the Rhode Island Health Care Reform Act of 2004 to give the health insurance commissioner new powers and duties. The commissioner will now be required to conduct quarterly public meetings to discuss the rates, services, and operations of health insurers in the state. They will also be responsible for making recommendations to the governor and legislative committees regarding healthcare insurance and the regulations, rates, services, administrative expenses, reserve requirements, and operations of insurers. The commissioner will establish an advisory council to obtain information and present concerns of consumers, businesses, and medical providers affected by health insurance decisions.

The bill also establishes a subcommittee of the advisory council called the professional-work group, which will provide information on fee schedules, standardized provider application and credentials verification processes, uniform health plan claim forms, and methods for making medical service-specific data available to patients. The subcommittee will also provide information on contractual disclosure to providers, confirmation of patient insurance enrollment status and benefits coverage, temporary credentialing of providers, contract renegotiations between plans and providers, and the impact of silent PPOs on physician practices. The bill also requires the commissioner to enforce certain provisions of the law, analyze the Rhode Island affordable health plan reinsurance fund, and analyze the impact of changing the rating guidelines and/or merging the individual and small-employer health insurance markets.

Statutes affected:
5495  SUB A: 42-14.5-3
5495: 42-14.5-3