The bill amends Section 42-14.5-3 of the Rhode Island General Laws to expand the duties of the health insurance commissioner. The commissioner is now required to hold quarterly public meetings to discuss health insurer rates, services, and operations, and their impact on stakeholders. Recommendations on healthcare insurance regulation must be made to the governor and finance committees, focusing on administrative expenses and reserve requirements. The bill also mandates the creation of an advisory council to develop proposals for affordable small business health insurance and to gather the health provider community's opinions on insurance rates and practices. The council is tasked with producing an annual report and establishing a subcommittee to address issues such as fee schedule disclosures, provider application standardization, and patient access to facility-specific data. The commissioner is given enforcement authority over titles 27 and 42, and must analyze the Rhode Island affordable health plan reinsurance fund and the individual and small-employer health insurance markets. The bill includes insertions of new legal language and deletions of previous legal language, although specific deletions are not detailed in the provided text.

The bill also requires the health insurance commissioner to conduct an analysis of the potential merger of the individual and small-group health insurance markets, considering factors like market size and rating factors. A task force will assist in this analysis, and the findings will be reported to the house and senate finance committees. A workgroup is to be established to streamline healthcare administration, focusing on standardizing electronic processes and developing guidelines for coding policies, claim denials, and fraud detection. The commissioner must submit a report by June 30, 2024, and a specific report on prescription drug prior authorizations by January 1, 2025. The bill emphasizes the need for annual reviews of medical services and prescription drugs requiring prior authorization, continuity of care, electronic prior authorization technology, and compliance with the Mental Health Parity Act. It also calls for various annual reports on healthcare aspects and the integration of behavioral health care with other medical services. The bill tasks the Office of the Health Insurance Commissioner with reviewing social and human service programs, establishing baselines, and ensuring accurate provider reimbursement. It sets a timeline for assessments and reports, with the first biennial assessment process to be completed by September 1, 2023, and requires departments to include assessment components in their annual budget submissions starting October 1, 2023. The General Assembly must appropriate funding for these activities, and the act will take effect upon passage.

Statutes affected:
7623: 42-14.5-3