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.
Impact
The proposed amendments are set to impact the policies governing the evaluation and adjustment of payment rates for primary care services. By ensuring that the recommendations on rates are part of a biennial review, the bill seeks to encourage consistent alignment with both federal and state payment requirements. The expected outcome is that primary care services will be subject to thorough assessments, making it easier for stakeholders—including providers and patients—to understand and respond to changes in care costs and funding allocations.
Summary
House Bill H5255 aims to amend sections of the Rhode Island Health Care Reform Act of 2004, specifically focusing on the inclusion of a definition for 'primary care services'. One of the primary provisions of the bill mandates that all biennial reports produced thereafter must incorporate a review and recommendations related to the rates for primary care services starting September 1, 2025. This provision signifies a shift towards formalized evaluations of primary care costs, promoting transparency and accountability in fiscal management within the state's healthcare framework.
Contention
While the bill primarily aims to enhance the transparency and efficiency of primary care services, potential points of contention may arise regarding how the defined 'primary care services' will be interpreted and the methodologies used for the rate-setting process. Stakeholders, particularly healthcare providers and insurers, may have differing views on what constitutes appropriate rates, and how these should compare with existing standards set by federal guidelines. Discussions around the adequacy of funding appropriated for the analyses and reports required by this bill may also present challenges as it moves through the legislative process.
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.
Requires that the department of human services and the department of behavioral healthcare, developmental disabilities and hospitals provide forecasted costs reflecting the recommended rate review on a monthly basis.
Requires that the department of human services and the department of behavioral healthcare, developmental disabilities and hospitals provide forecasted costs reflecting the recommended rate review on a monthly basis.
Protects the solvency of health systems, physicians, and advance practice providers and insurers, encourage fair treatment of hospitals and ensure adequate clinical workforce while advancing health equity.
Protects the solvency of health systems, physicians, and advance practice providers and insurers, encourage fair treatment of hospitals and ensure adequate clinical workforce while advancing health equity.
All Medicaid programs operated by EOHHS would not reimburse home care providers less than fee-for-service rates adopted by rate review recommendations of the office of health insurance commissioners.
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.
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.