Amends the current law in order that a health insurer would not require a physician, to participate in "capitation," or any other "alternative payment model" that creates a financial incentive for a physician to limit medically necessary care.
Extends coverage for treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome by removing the sunset date of December 31, 2025, and mandating such coverage.
Establishes a rare disease advisory council within the department of health to provide guidance and recommendations to educate healthcare providers and the citizens of the state.
Requires health insurance plans to cover services provided by licensed certified professional midwives. Insurers must report utilization and cost data annually. Certain limited benefit policies are exempt.
Requires the department of health to incorporate information about dementia risk factors and reduction into public education and healthcare provider education materials.
Amends the types of products which pharmacists may prescribe as substitute drugs or products to include "devices and supplies" and "therapeutically equivalent drugs and pharmaceuticals".
Establishes, encourages and supports the establishment of family councils and resident councils in managed residential communities providing assisted living services.
Limits prior authorization requirements for rehabilitative and habilitative services. Also prohibits prior authorization for the first twelve (12) visits of a new episode of care and for ninety (90) days following a chronic pain diagnosis.
Establishes a process whereby large drug manufacturers, may be penalized for prescription drug price increases where there is no, or inadequate, new evidence to support the price increase.
Establishes that Medicaid eligibility in RI can only be determined using state-controlled data, prohibit private entity data in eligibility decisions, and ensure terminations are made by human employees rather than automated systems.