Requires a report to be produced that focuses on prescription drug prior authorizations by January 1, 2025.
Impact
If passed, S2614 would enhance the oversight mechanisms for health insurers in the state. This includes establishing rules to report on the impacts of prior authorization requirements on healthcare delivery. It emphasizes the need for ongoing public meetings and consultations between the health insurance commissioner, consumers, and medical care providers, aiming to allow feedback on insurance practices that affect patients' access to necessary treatments. Additionally, the bill reinforces the state’s commitment to regulating health insurance in a manner that is transparent and accountable.
Summary
Senate Bill S2614 focuses on improving health insurance oversight in Rhode Island by amending the Rhode Island Health Care Reform Act of 2004. The primary objective of the bill is to require the Office of the Health Insurance Commissioner to produce a report on prescription drug prior authorizations by January 1, 2025. This report is intended to address existing challenges and efficiencies in the prior authorization processes that impact patient care and medical service provision. By examining these processes, the bill aims to foster transparency and accessibility for both consumers and healthcare providers in the insurance landscape.
Contention
Debates surrounding the bill may arise regarding how prior authorization practices can hinder timely patient access to medications and treatments. Proponents of the bill argue that by requiring detailed oversight and reporting from health insurers, the bill will highlight unnecessary obstacles in patient care delivery. Conversely, some critics may raise concerns about the administrative burden that increased oversight could impose on healthcare providers and insurers, potentially complicating processes in an already complex healthcare landscape.
Includes the definition of "primary care services" and requires that all biennial reports shall include a review and recommendation of rates for primary care services on and after September 1, 2025.
Includes the definition of "primary care services" and requires that all biennial reports shall include a review and recommendation of rates for primary care services on and after September 1, 2025.
Includes the definition of "primary care services" and requires that all biennial reports shall include a review and recommendation of rates for primary care services on and after September 1, 2025.
Amends powers/duties of the office of the health insurance commissioner to increase total cost of care for services reimbursed under contracts after risk adjustment that exceeds the Consumer Price Index for all Urban Consumers percentage increase.
Amends powers/duties of the office of the health insurance commissioner to increase total cost of care for services reimbursed under contracts after risk adjustment that exceeds the Consumer Price Index for all Urban Consumers percentage increase.
Limits the use by insurers of step therapy, a protocol that establishes a specific sequence in which prescription drugs for a specified medical condition are covered by an insurer, by allowing medical providers to request step therapy exceptions.
Limits the use by insurers of step therapy, a protocol that establishes a specific sequence in which prescription drugs for a specified medical condition are covered by an insurer, by allowing medical providers to request step therapy exceptions.
Limits the use by insurers of step therapy, a protocol that establishes a specific sequence in which prescription drugs for a specified medical condition are covered by an insurer, by allowing medical providers to request step therapy exceptions.