The bill amends Section 42-14.5-3 of the Rhode Island General Laws to enhance the responsibilities of the health insurance commissioner, including conducting quarterly public meetings, making recommendations to the governor and finance committees, and ensuring transparency in health insurers' operations. It establishes a consumer/business/labor/medical advisory council to address health insurance concerns and develop proposals for a fair small business health insurance market. The bill also creates a subcommittee to report on healthcare provider and health plan interactions, and gives the commissioner authority to enforce provisions of titles 27 and 42, analyze the reinsurance fund, and assess the impact of changes to the health insurance markets. It requires an analysis of the potential merger of the individual and small-group markets, examining the adequacy of current oversight, reinsurance mechanisms, and the impact of broker and tobacco use rating factors, with findings to be included in an annual report.

Furthermore, the bill mandates the establishment of a workgroup to streamline healthcare administration, which will develop processes and standards for administrative functions and submit recommendations to the commissioner. The commissioner is to report to the general assembly by June 30, 2024, and provide a focused report on prescription drug prior authorizations by January 1, 2025. The bill includes insertions that specify the workgroup members must comply with the commissioner's requests for information and documents within set timelines, and the commissioner has enforcement authority to implement this section. The bill also aims to improve healthcare services and patient care by mandating the annual review of medical services and prescription drugs requiring prior authorization, enhancing communication and transparency, and focusing on continuity of care. It sets forth various reporting requirements to the house and senate on topics such as anti-cancer medication coverage and the impact of healthcare mandates on insurance costs. The bill requires the Office of the Health Insurance Commissioner to submit a comprehensive analysis report to the General Assembly by June 1, 2023, and outlines a detailed timeline for various assessments and reports to be completed by specific dates in 2023.

Statutes affected:
2614: 42-14.5-3