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| 4 | 4 | | |
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| 5 | 5 | | 2025 -- H 5429 |
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| 6 | 6 | | ======== |
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| 7 | 7 | | LC001524 |
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| 8 | 8 | | ======== |
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| 9 | 9 | | S T A T E O F R H O D E I S L A N D |
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| 10 | 10 | | IN GENERAL ASSEMBLY |
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| 11 | 11 | | JANUARY SESSION, A.D. 2025 |
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| 12 | 12 | | ____________ |
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| 13 | 13 | | |
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| 14 | 14 | | A N A C T |
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| 15 | 15 | | RELATING TO INSURANCE -- THIRD-PARTY HEALTH INSURANCE |
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| 16 | 16 | | ADMINISTRATORS -- PRESCRIPTION DRUG COST CONTROL AND TRANSPA RENCY |
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| 17 | 17 | | Introduced By: Representatives J. Lombardi, Hull, Sanchez, Cruz, Potter, Stewart, |
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| 18 | 18 | | Alzate, Voas, Diaz, and Morales |
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| 19 | 19 | | Date Introduced: February 12, 2025 |
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| 20 | 20 | | Referred To: House Health & Human Services |
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| 21 | 21 | | |
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| 22 | 22 | | |
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| 23 | 23 | | It is enacted by the General Assembly as follows: |
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| 24 | 24 | | SECTION 1. Legislative intent. 1 |
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| 25 | 25 | | The intent of this legislation is to protect Rhode Islanders from high prescription drug costs 2 |
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| 26 | 26 | | by requiring greater pharmacy benefit manager ( P B M ) transparency and accountability. 3 |
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| 27 | 27 | | SECTION 2. Section 27-20.7-12 of the General Laws in Chapter 27-20.7 entitled "Third-4 |
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| 28 | 28 | | Party Health Insurance Administrators" is hereby amended to read as follows: 5 |
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| 29 | 29 | | 27-20.7-12. Certificate of authority required. 6 |
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| 30 | 30 | | (a) No person shall act as, or offer to act as, or hold himself or herself out to be an 7 |
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| 31 | 31 | | administrator in this state without a valid certificate of authority as an administrator issued by the 8 |
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| 32 | 32 | | commissioner. 9 |
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| 33 | 33 | | (b) Applicants to be an administrator shall make an application to the commissioner upon 10 |
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| 34 | 34 | | a form to be furnished by the commissioner. The application shall include or be accompanied by 11 |
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| 35 | 35 | | the following information and documents: 12 |
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| 36 | 36 | | (1) All basic organizational documents of the administrator, including any articles of 13 |
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| 37 | 37 | | incorporation, articles of association, partnership agreement, trade name certificate, trust 14 |
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| 38 | 38 | | agreement, shareholder agreement, and other applicable documents and all amendments to those 15 |
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| 39 | 39 | | documents; 16 |
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| 40 | 40 | | (2) The bylaws, rules, regulations, or similar documents regulating the internal affairs of 17 |
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| 41 | 41 | | the administrator; 18 |
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| 42 | 42 | | |
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| 43 | 43 | | |
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| 44 | 44 | | LC001524 - Page 2 of 16 |
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| 45 | 45 | | (3) The names, addresses, official positions, and professional qualifications of the 1 |
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| 46 | 46 | | individuals who are responsible for the conduct of affairs of the administrator; including all 2 |
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| 47 | 47 | | members of the board of directors, board of trustees, executive committee, or other governing board 3 |
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| 48 | 48 | | or committee; the principal officers in the case of a corporation or the partners or members in the 4 |
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| 49 | 49 | | case of a partnership or association; shareholders holding directly or indirectly ten percent (10%) 5 |
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| 50 | 50 | | or more of the voting securities of the administrator; and any other person who exercises control or 6 |
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| 51 | 51 | | influence over the affairs of the administrator; 7 |
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| 52 | 52 | | (4) Annual financial statements or reports for the two (2) most recent years which prove 8 |
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| 53 | 53 | | that the applicant is solvent and any information that the commissioner may require in order to 9 |
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| 54 | 54 | | review the current financial condition of the applicant; 10 |
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| 55 | 55 | | (5) A statement describing the business plan including information on staffing levels and 11 |
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| 56 | 56 | | activities proposed in this state and nationwide. The plan must provide details setting forth the 12 |
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| 57 | 57 | | administrator’s capability for providing a sufficient number of experienced and qualified personnel 13 |
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| 58 | 58 | | in the areas of claims processing, recordkeeping and underwriting; 14 |
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| 59 | 59 | | (6) If the applicant will be managing the solicitation of new or renewal business, proof that 15 |
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| 60 | 60 | | it employs or has contracted with an agent licensed by this state for solicitation and taking of 16 |
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| 61 | 61 | | applications. An applicant that intends to directly solicit insurance contracts or to act as an insurance 17 |
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| 62 | 62 | | producer must provide proof that it has a license as an insurance producer in this state; and 18 |
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| 63 | 63 | | (7) Information required pursuant to §27-29.1-7; and 19 |
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| 64 | 64 | | (8) Any other pertinent information that may be required by the commissioner. 20 |
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| 65 | 65 | | (c) The applicant shall make available, for inspection by the commissioner, copies of all 21 |
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| 66 | 66 | | contracts with insurers or other persons utilizing the services of the administrator. 22 |
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| 67 | 67 | | (d) The commissioner may refuse to issue a certificate of authority if the commissioner 23 |
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| 68 | 68 | | determines that the administrator, or any individual responsible for the conduct of affairs of the 24 |
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| 69 | 69 | | administrator as defined in subsection (b)(3) of this section, is not competent, trustworthy, 25 |
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| 70 | 70 | | financially responsible or of good personal and business reputation, or has had an insurance or an 26 |
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| 71 | 71 | | administrator license denied or revoked for cause by any state. 27 |
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| 72 | 72 | | (e) A certificate of authority issued under this section shall remain valid, unless 28 |
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| 73 | 73 | | surrendered, suspended, or revoked by the commissioner, for so long as the administrator continues 29 |
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| 74 | 74 | | in business in this state and remains in compliance with this chapter. 30 |
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| 75 | 75 | | (f) An administrator is not required to hold a certificate of authority as an administrator in 31 |
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| 76 | 76 | | this state if all of the following conditions are met: 32 |
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| 77 | 77 | | (1) The administrator has its principal place of business in another state; 33 |
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| 78 | 78 | | (2) The administrator is not soliciting business as an administrator in this state; 34 |
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| 79 | 79 | | |
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| 80 | 80 | | |
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| 81 | 81 | | LC001524 - Page 3 of 16 |
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| 82 | 82 | | (3) In the case of any group policy or plan of insurance serviced by the administrator, the 1 |
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| 83 | 83 | | lesser of five percent (5%) or one hundred (100) certificate holders reside in this state. 2 |
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| 84 | 84 | | (g) A person is not required to hold a certificate of authority as an administrator in this state 3 |
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| 85 | 85 | | if the person exclusively provides services to one or more bona fide employee benefit plans each 4 |
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| 86 | 86 | | of which is established by an employer or an employee organization, or both, and for which the 5 |
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| 87 | 87 | | insurance laws of this state are preempted pursuant to the Employee Retirement Income Security 6 |
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| 88 | 88 | | Act of 1974, 29 U.S.C. § 1001 et seq. These persons shall register with the commissioner annually, 7 |
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| 89 | 89 | | verifying their status as described in this section. 8 |
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| 90 | 90 | | (h) An administrator shall immediately notify the commissioner of any material change in 9 |
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| 91 | 91 | | its ownership, control, or other fact or circumstance affecting its qualification for a certificate of 10 |
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| 92 | 92 | | authority in this state. 11 |
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| 93 | 93 | | (i) No bonding shall be required by the commissioner of any administrator whose business 12 |
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| 94 | 94 | | is restricted solely to benefit plans that are either fully insured by an authorized insurer or that are 13 |
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| 95 | 95 | | bona fide employee benefit plans established by an employer or any employee organization, or 14 |
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| 96 | 96 | | both, for which the insurance laws of this state are preempted pursuant to the Employee Retirement 15 |
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| 97 | 97 | | Income Security Act of 1974, 29 U.S.C. § 1001 et seq. 16 |
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| 98 | 98 | | SECTION 3. Section 27-29.1-7 of the General Laws in Chapter 27-29.1 entitled "Pharmacy 17 |
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| 99 | 99 | | Freedom of Choice — Fair Competition and Practices" is hereby amended to read as follows: 18 |
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| 100 | 100 | | 27-29.1-7. Regulation of pharmacy benefits managers. 19 |
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| 101 | 101 | | (a) Pharmacy benefits managers shall be included within the definition of third-party 20 |
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| 102 | 102 | | administrator under chapter 20.7 of this title and shall be regulated as such. The annual report filed 21 |
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| 103 | 103 | | by third-party administrators with the department of business regulation shall include: contractual 22 |
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| 104 | 104 | | language that provides a complete description of the financial arrangements between the third-party 23 |
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| 105 | 105 | | administrator and each of the insurers covering benefit contracts delivered in Rhode Island; and if 24 |
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| 106 | 106 | | the third-party administrator is owned by or affiliated with another entity or entities, it shall include 25 |
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| 107 | 107 | | an organization chart and brief description that shows the relationships among all affiliates within 26 |
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| 108 | 108 | | a holding company or otherwise affiliated. The reporting shall be in a format required by the 27 |
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| 109 | 109 | | director and filed with the department as a public record as defined and regulated under chapter 2 28 |
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| 110 | 110 | | of title 38. 29 |
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| 111 | 111 | | (b) Pharmacy benefit managers shall: 30 |
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| 112 | 112 | | (1) Cease activities that result in spread pricing, a payment model where the pharmacy 31 |
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| 113 | 113 | | benefit manager charges a health plan more than it reimburses the pharmacy for a prescription drug 32 |
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| 114 | 114 | | and retains the difference; 33 |
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| 115 | 115 | | (2) Use pass-through pricing, a payment model where the pharmacy benefit manager 34 |
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| 116 | 116 | | |
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| 117 | 117 | | |
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| 118 | 118 | | LC001524 - Page 4 of 16 |
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| 119 | 119 | | charges the health plan or insurer the same amount it reimburses the pharmacy, with no additional 1 |
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| 120 | 120 | | profit margin, and retains only a pre-determined administrative fee; 2 |
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| 121 | 121 | | (3) Cease discriminatory treatment of non-affiliated pharmacies and pharmacists; 3 |
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| 122 | 122 | | (4) Cease utilization management processes, including prior authorizations, step therapy, 4 |
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| 123 | 123 | | and non-medical drug switching, that delay, reduce, or prevent medically necessary care; 5 |
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| 124 | 124 | | (5) Ensure enrollee benefits result from discounts, price reductions, or other financial 6 |
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| 125 | 125 | | incentives provided to pharmacy benefit managers by drug manufacturers including, but not limited 7 |
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| 126 | 126 | | to, rebates for formulary placements; 8 |
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| 127 | 127 | | (6) Provide information and documents that permit enforcement of this subsection to 9 |
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| 128 | 128 | | executive office of health and human services or the office of the health insurance commissioner, 10 |
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| 129 | 129 | | upon request. 11 |
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| 130 | 130 | | SECTION 4. Section 42-14.5-3 of the General Laws in Chapter 42-14.5 entitled "The 12 |
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| 131 | 131 | | Rhode Island Health Care Reform Act of 2004 — Health Insurance Oversight" is hereby amended 13 |
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| 132 | 132 | | to read as follows: 14 |
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| 133 | 133 | | 42-14.5-3. Powers and duties. 15 |
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| 134 | 134 | | The health insurance commissioner shall have the following powers and duties: 16 |
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| 135 | 135 | | (a) To conduct quarterly public meetings throughout the state, separate and distinct from 17 |
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| 136 | 136 | | rate hearings pursuant to § 42-62-13, regarding the rates, services, and operations of insurers 18 |
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| 137 | 137 | | licensed to provide health insurance in the state; the effects of such rates, services, and operations 19 |
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| 138 | 138 | | on consumers, medical care providers, patients, and the market environment in which the insurers 20 |
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| 139 | 139 | | operate; and efforts to bring new health insurers into the Rhode Island market. Notice of not less 21 |
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| 140 | 140 | | than ten (10) days of the hearing(s) shall go to the general assembly, the governor, the Rhode Island 22 |
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| 141 | 141 | | Medical Society, the Hospital Association of Rhode Island, the director of health, the attorney 23 |
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| 142 | 142 | | general, and the chambers of commerce. Public notice shall be posted on the department’s website 24 |
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| 143 | 143 | | and given in the newspaper of general circulation, and to any entity in writing requesting notice. 25 |
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| 144 | 144 | | (b) To make recommendations to the governor and the house of representatives and senate 26 |
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| 145 | 145 | | finance committees regarding healthcare insurance and the regulations, rates, services, 27 |
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| 146 | 146 | | administrative expenses, reserve requirements, and operations of insurers providing health 28 |
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| 147 | 147 | | insurance in the state, and to prepare or comment on, upon the request of the governor or 29 |
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| 148 | 148 | | chairpersons of the house or senate finance committees, draft legislation to improve the regulation 30 |
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| 149 | 149 | | of health insurance. In making the recommendations, the commissioner shall recognize that it is 31 |
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| 150 | 150 | | the intent of the legislature that the maximum disclosure be provided regarding the reasonableness 32 |
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| 151 | 151 | | of individual administrative expenditures as well as total administrative costs. The commissioner 33 |
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| 152 | 152 | | shall make recommendations on the levels of reserves, including consideration of: targeted reserve 34 |
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| 153 | 153 | | |
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| 154 | 154 | | |
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| 155 | 155 | | LC001524 - Page 5 of 16 |
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| 156 | 156 | | levels; trends in the increase or decrease of reserve levels; and insurer plans for distributing excess 1 |
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| 157 | 157 | | reserves. 2 |
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| 158 | 158 | | (c) To establish a consumer/business/labor/medical advisory council to obtain information 3 |
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| 159 | 159 | | and present concerns of consumers, business, and medical providers affected by health insurance 4 |
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| 160 | 160 | | decisions. The council shall develop proposals to allow the market for small business health 5 |
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| 161 | 161 | | insurance to be affordable and fairer. The council shall be involved in the planning and conduct of 6 |
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| 162 | 162 | | the quarterly public meetings in accordance with subsection (a). The advisory council shall develop 7 |
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| 163 | 163 | | measures to inform small businesses of an insurance complaint process to ensure that small 8 |
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| 164 | 164 | | businesses that experience rate increases in a given year may request and receive a formal review 9 |
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| 165 | 165 | | by the department. The advisory council shall assess views of the health provider community 10 |
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| 166 | 166 | | relative to insurance rates of reimbursement, billing, and reimbursement procedures, and the 11 |
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| 167 | 167 | | insurers’ role in promoting efficient and high-quality health care. The advisory council shall issue 12 |
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| 168 | 168 | | an annual report of findings and recommendations to the governor and the general assembly and 13 |
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| 169 | 169 | | present its findings at hearings before the house and senate finance committees. The advisory 14 |
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| 170 | 170 | | council is to be diverse in interests and shall include representatives of community consumer 15 |
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| 171 | 171 | | organizations; small businesses, other than those involved in the sale of insurance products; and 16 |
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| 172 | 172 | | hospital, medical, and other health provider organizations. Such representatives shall be nominated 17 |
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| 173 | 173 | | by their respective organizations. The advisory council shall be co-chaired by the health insurance 18 |
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| 174 | 174 | | commissioner and a community consumer organization or small business member to be elected by 19 |
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| 175 | 175 | | the full advisory council. 20 |
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| 176 | 176 | | (d) To establish and provide guidance and assistance to a subcommittee (“the professional-21 |
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| 177 | 177 | | provider-health-plan work group”) of the advisory council created pursuant to subsection (c), 22 |
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| 178 | 178 | | composed of healthcare providers and Rhode Island licensed health plans. This subcommittee shall 23 |
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| 179 | 179 | | include in its annual report and presentation before the house and senate finance committees the 24 |
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| 180 | 180 | | following information: 25 |
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| 181 | 181 | | (1) A method whereby health plans shall disclose to contracted providers the fee schedules 26 |
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| 182 | 182 | | used to provide payment to those providers for services rendered to covered patients; 27 |
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| 183 | 183 | | (2) A standardized provider application and credentials verification process, for the 28 |
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| 184 | 184 | | purpose of verifying professional qualifications of participating healthcare providers; 29 |
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| 185 | 185 | | (3) The uniform health plan claim form utilized by participating providers; 30 |
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| 186 | 186 | | (4) Methods for health maintenance organizations, as defined by § 27-41-2, and nonprofit 31 |
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| 187 | 187 | | hospital or medical service corporations, as defined by chapters 19 and 20 of title 27, to make 32 |
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| 188 | 188 | | facility-specific data and other medical service-specific data available in reasonably consistent 33 |
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| 189 | 189 | | formats to patients regarding quality and costs. This information would help consumers make 34 |
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| 190 | 190 | | |
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| 191 | 191 | | |
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| 192 | 192 | | LC001524 - Page 6 of 16 |
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| 193 | 193 | | informed choices regarding the facilities and clinicians or physician practices at which to seek care. 1 |
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| 194 | 194 | | Among the items considered would be the unique health services and other public goods provided 2 |
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| 195 | 195 | | by facilities and clinicians or physician practices in establishing the most appropriate cost 3 |
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| 196 | 196 | | comparisons; 4 |
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| 197 | 197 | | (5) All activities related to contractual disclosure to participating providers of the 5 |
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| 198 | 198 | | mechanisms for resolving health plan/provider disputes; 6 |
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| 199 | 199 | | (6) The uniform process being utilized for confirming, in real time, patient insurance 7 |
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| 200 | 200 | | enrollment status, benefits coverage, including copays and deductibles; 8 |
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| 201 | 201 | | (7) Information related to temporary credentialing of providers seeking to participate in the 9 |
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| 202 | 202 | | plan’s network and the impact of the activity on health plan accreditation; 10 |
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| 203 | 203 | | (8) The feasibility of regular contract renegotiations between plans and the providers in 11 |
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| 204 | 204 | | their networks; and 12 |
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| 205 | 205 | | (9) Efforts conducted related to reviewing impact of silent PPOs on physician practices. 13 |
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| 206 | 206 | | (e) To enforce the provisions of title 27 and title 42 as set forth in § 42-14-5(d). 14 |
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| 207 | 207 | | (f) To provide analysis of the Rhode Island affordable health plan reinsurance fund. The 15 |
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| 208 | 208 | | fund shall be used to effectuate the provisions of §§ 27-18.5-9 and 27-50-17. 16 |
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| 209 | 209 | | (g) To analyze the impact of changing the rating guidelines and/or merging the individual 17 |
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| 210 | 210 | | health insurance market, as defined in chapter 18.5 of title 27, and the small-employer health 18 |
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| 211 | 211 | | insurance market, as defined in chapter 50 of title 27, in accordance with the following: 19 |
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| 212 | 212 | | (1) The analysis shall forecast the likely rate increases required to effect the changes 20 |
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| 213 | 213 | | recommended pursuant to the preceding subsection (g) in the direct-pay market and small-employer 21 |
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| 214 | 214 | | health insurance market over the next five (5) years, based on the current rating structure and 22 |
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| 215 | 215 | | current products. 23 |
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| 216 | 216 | | (2) The analysis shall include examining the impact of merging the individual and small-24 |
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| 217 | 217 | | employer markets on premiums charged to individuals and small-employer groups. 25 |
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| 218 | 218 | | (3) The analysis shall include examining the impact on rates in each of the individual and 26 |
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| 219 | 219 | | small-employer health insurance markets and the number of insureds in the context of possible 27 |
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| 220 | 220 | | changes to the rating guidelines used for small-employer groups, including: community rating 28 |
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| 221 | 221 | | principles; expanding small-employer rate bonds beyond the current range; increasing the employer 29 |
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| 222 | 222 | | group size in the small-group market; and/or adding rating factors for broker and/or tobacco use. 30 |
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| 223 | 223 | | (4) The analysis shall include examining the adequacy of current statutory and regulatory 31 |
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| 224 | 224 | | oversight of the rating process and factors employed by the participants in the proposed, new 32 |
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| 225 | 225 | | merged market. 33 |
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| 226 | 226 | | (5) The analysis shall include assessment of possible reinsurance mechanisms and/or 34 |
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| 227 | 227 | | |
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| 228 | 228 | | |
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| 229 | 229 | | LC001524 - Page 7 of 16 |
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| 230 | 230 | | federal high-risk pool structures and funding to support the health insurance market in Rhode Island 1 |
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| 231 | 231 | | by reducing the risk of adverse selection and the incremental insurance premiums charged for this 2 |
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| 232 | 232 | | risk, and/or by making health insurance affordable for a selected at-risk population. 3 |
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| 233 | 233 | | (6) The health insurance commissioner shall work with an insurance market merger task 4 |
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| 234 | 234 | | force to assist with the analysis. The task force shall be chaired by the health insurance 5 |
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| 235 | 235 | | commissioner and shall include, but not be limited to, representatives of the general assembly, the 6 |
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| 236 | 236 | | business community, small-employer carriers as defined in § 27-50-3, carriers offering coverage in 7 |
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| 237 | 237 | | the individual market in Rhode Island, health insurance brokers, and members of the general public. 8 |
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| 238 | 238 | | (7) For the purposes of conducting this analysis, the commissioner may contract with an 9 |
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| 239 | 239 | | outside organization with expertise in fiscal analysis of the private insurance market. In conducting 10 |
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| 240 | 240 | | its study, the organization shall, to the extent possible, obtain and use actual health plan data. Said 11 |
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| 241 | 241 | | data shall be subject to state and federal laws and regulations governing confidentiality of health 12 |
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| 242 | 242 | | care and proprietary information. 13 |
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| 243 | 243 | | (8) The task force shall meet as necessary and include its findings in the annual report, and 14 |
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| 244 | 244 | | the commissioner shall include the information in the annual presentation before the house and 15 |
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| 245 | 245 | | senate finance committees. 16 |
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| 246 | 246 | | (h) To establish and convene a workgroup representing healthcare providers and health 17 |
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| 247 | 247 | | insurers for the purpose of coordinating the development of processes, guidelines, and standards to 18 |
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| 248 | 248 | | streamline healthcare administration that are to be adopted by payors and providers of healthcare 19 |
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| 249 | 249 | | services operating in the state. This workgroup shall include representatives with expertise who 20 |
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| 250 | 250 | | would contribute to the streamlining of healthcare administration and who are selected from 21 |
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| 251 | 251 | | hospitals, physician practices, community behavioral health organizations, each health insurer, and 22 |
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| 252 | 252 | | other affected entities. The workgroup shall also include at least one designee each from the Rhode 23 |
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| 253 | 253 | | Island Medical Society, Rhode Island Council of Community Mental Health Organizations, the 24 |
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| 254 | 254 | | Rhode Island Health Center Association, and the Hospital Association of Rhode Island. In any year 25 |
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| 255 | 255 | | that the workgroup meets and submits recommendations to the office of the health insurance 26 |
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| 256 | 256 | | commissioner, the office of the health insurance commissioner shall submit such recommendations 27 |
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| 257 | 257 | | to the health and human services committees of the Rhode Island house of representatives and the 28 |
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| 258 | 258 | | Rhode Island senate prior to the implementation of any such recommendations and subsequently 29 |
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| 259 | 259 | | shall submit a report to the general assembly by June 30, 2024. The report shall include the 30 |
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| 260 | 260 | | recommendations the commissioner may implement, with supporting rationale. The workgroup 31 |
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| 261 | 261 | | shall consider and make recommendations for: 32 |
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| 262 | 262 | | (1) Establishing a consistent standard for electronic eligibility and coverage verification. 33 |
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| 263 | 263 | | Such standard shall: 34 |
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| 264 | 264 | | |
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| 265 | 265 | | |
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| 266 | 266 | | LC001524 - Page 8 of 16 |
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| 267 | 267 | | (i) Include standards for eligibility inquiry and response and, wherever possible, be 1 |
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| 268 | 268 | | consistent with the standards adopted by nationally recognized organizations, such as the Centers 2 |
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| 269 | 269 | | for Medicare & Medicaid Services; 3 |
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| 270 | 270 | | (ii) Enable providers and payors to exchange eligibility requests and responses on a system-4 |
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| 271 | 271 | | to-system basis or using a payor-supported web browser; 5 |
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| 272 | 272 | | (iii) Provide reasonably detailed information on a consumer’s eligibility for healthcare 6 |
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| 273 | 273 | | coverage; scope of benefits; limitations and exclusions provided under that coverage; cost-sharing 7 |
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| 274 | 274 | | requirements for specific services at the specific time of the inquiry; current deductible amounts; 8 |
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| 275 | 275 | | accumulated or limited benefits; out-of-pocket maximums; any maximum policy amounts; and 9 |
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| 276 | 276 | | other information required for the provider to collect the patient’s portion of the bill; 10 |
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| 277 | 277 | | (iv) Reflect the necessary limitations imposed on payors by the originator of the eligibility 11 |
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| 278 | 278 | | and benefits information; 12 |
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| 279 | 279 | | (v) Recommend a standard or common process to protect all providers from the costs of 13 |
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| 280 | 280 | | services to patients who are ineligible for insurance coverage in circumstances where a payor 14 |
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| 281 | 281 | | provides eligibility verification based on best information available to the payor at the date of the 15 |
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| 282 | 282 | | request of eligibility. 16 |
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| 283 | 283 | | (2) Developing implementation guidelines and promoting adoption of the guidelines for: 17 |
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| 284 | 284 | | (i) The use of the National Correct Coding Initiative code-edit policy by payors and 18 |
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| 285 | 285 | | providers in the state; 19 |
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| 286 | 286 | | (ii) Publishing any variations from codes and mutually exclusive codes by payors in a 20 |
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| 287 | 287 | | manner that makes for simple retrieval and implementation by providers; 21 |
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| 288 | 288 | | (iii) Use of Health Insurance Portability and Accountability Act standard group codes, 22 |
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| 289 | 289 | | reason codes, and remark codes by payors in electronic remittances sent to providers; 23 |
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| 290 | 290 | | (iv) Uniformity in the processing of claims by payors; and the processing of corrections to 24 |
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| 291 | 291 | | claims by providers and payors; 25 |
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| 292 | 292 | | (v) A standard payor-denial review process for providers when they request a 26 |
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| 293 | 293 | | reconsideration of a denial of a claim that results from differences in clinical edits where no single, 27 |
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| 294 | 294 | | common-standards body or process exists and multiple conflicting sources are in use by payors and 28 |
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| 295 | 295 | | providers. 29 |
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| 296 | 296 | | (vi) Nothing in this section, nor in the guidelines developed, shall inhibit an individual 30 |
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| 297 | 297 | | payor’s ability to employ, and not disclose to providers, temporary code edits for the purpose of 31 |
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| 298 | 298 | | detecting and deterring fraudulent billing activities. The guidelines shall require that each payor 32 |
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| 299 | 299 | | disclose to the provider its adjudication decision on a claim that was denied or adjusted based on 33 |
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| 300 | 300 | | the application of such edits and that the provider have access to the payor’s review and appeal 34 |
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| 301 | 301 | | |
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| 302 | 302 | | |
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| 303 | 303 | | LC001524 - Page 9 of 16 |
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| 304 | 304 | | process to challenge the payor’s adjudication decision. 1 |
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| 305 | 305 | | (vii) Nothing in this subsection shall be construed to modify the rights or obligations of 2 |
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| 306 | 306 | | payors or providers with respect to procedures relating to the investigation, reporting, appeal, or 3 |
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| 307 | 307 | | prosecution under applicable law of potentially fraudulent billing activities. 4 |
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| 308 | 308 | | (3) Developing and promoting widespread adoption by payors and providers of guidelines 5 |
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| 309 | 309 | | to: 6 |
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| 310 | 310 | | (i) Ensure payors do not automatically deny claims for services when extenuating 7 |
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| 311 | 311 | | circumstances make it impossible for the provider to obtain a preauthorization before services are 8 |
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| 312 | 312 | | performed or notify a payor within an appropriate standardized timeline of a patient’s admission; 9 |
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| 313 | 313 | | (ii) Require payors to use common and consistent processes and time frames when 10 |
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| 314 | 314 | | responding to provider requests for medical management approvals. Whenever possible, such time 11 |
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| 315 | 315 | | frames shall be consistent with those established by leading national organizations and be based 12 |
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| 316 | 316 | | upon the acuity of the patient’s need for care or treatment. For the purposes of this section, medical 13 |
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| 317 | 317 | | management includes prior authorization of services, preauthorization of services, precertification 14 |
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| 318 | 318 | | of services, post-service review, medical-necessity review, and benefits advisory; 15 |
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| 319 | 319 | | (iii) Develop, maintain, and promote widespread adoption of a single, common website 16 |
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| 320 | 320 | | where providers can obtain payors’ preauthorization, benefits advisory, and preadmission 17 |
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| 321 | 321 | | requirements; 18 |
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| 322 | 322 | | (iv) Establish guidelines for payors to develop and maintain a website that providers can 19 |
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| 323 | 323 | | use to request a preauthorization, including a prospective clinical necessity review; receive an 20 |
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| 324 | 324 | | authorization number; and transmit an admission notification; 21 |
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| 325 | 325 | | (v) Develop and implement the use of programs that implement selective prior 22 |
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| 326 | 326 | | authorization requirements, based on stratification of healthcare providers’ performance and 23 |
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| 327 | 327 | | adherence to evidence-based medicine with the input of contracted healthcare providers and/or 24 |
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| 328 | 328 | | provider organizations. Such criteria shall be transparent and easily accessible to contracted 25 |
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| 329 | 329 | | providers. Such selective prior authorization programs shall be available when healthcare providers 26 |
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| 330 | 330 | | participate directly with the insurer in risk-based payment contracts and may be available to 27 |
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| 331 | 331 | | providers who do not participate in risk-based contracts; 28 |
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| 332 | 332 | | (vi) Require the review of medical services, including behavioral health services, and 29 |
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| 333 | 333 | | prescription drugs, subject to prior authorization on at least an annual basis, with the input of 30 |
|---|
| 334 | 334 | | contracted healthcare providers and/or provider organizations. Any changes to the list of medical 31 |
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| 335 | 335 | | services, including behavioral health services, and prescription drugs requiring prior authorization, 32 |
|---|
| 336 | 336 | | shall be shared via provider-accessible websites; 33 |
|---|
| 337 | 337 | | (vii) Improve communication channels between health plans, healthcare providers, and 34 |
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| 338 | 338 | | |
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| 339 | 339 | | |
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| 340 | 340 | | LC001524 - Page 10 of 16 |
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| 341 | 341 | | patients by: 1 |
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| 342 | 342 | | (A) Requiring transparency and easy accessibility of prior authorization requirements, 2 |
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| 343 | 343 | | criteria, rationale, and program changes to contracted healthcare providers and patients/health plan 3 |
|---|
| 344 | 344 | | enrollees which may be satisfied by posting to provider-accessible and member-accessible 4 |
|---|
| 345 | 345 | | websites; and 5 |
|---|
| 346 | 346 | | (B) Supporting: 6 |
|---|
| 347 | 347 | | (I) Timely submission by healthcare providers of the complete information necessary to 7 |
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| 348 | 348 | | make a prior authorization determination, as early in the process as possible; and 8 |
|---|
| 349 | 349 | | (II) Timely notification of prior authorization determinations by health plans to impacted 9 |
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| 350 | 350 | | health plan enrollees, and healthcare providers, including, but not limited to, ordering providers, 10 |
|---|
| 351 | 351 | | and/or rendering providers, and dispensing pharmacists which may be satisfied by posting to 11 |
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| 352 | 352 | | provider-accessible websites or similar electronic portals or services; 12 |
|---|
| 353 | 353 | | (viii) Increase and strengthen continuity of patient care by: 13 |
|---|
| 354 | 354 | | (A) Defining protections for continuity of care during a transition period for patients 14 |
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| 355 | 355 | | undergoing an active course of treatment, when there is a formulary or treatment coverage change 15 |
|---|
| 356 | 356 | | or change of health plan that may disrupt their current course of treatment and when the treating 16 |
|---|
| 357 | 357 | | physician determines that a transition may place the patient at risk; and for prescription medication 17 |
|---|
| 358 | 358 | | by allowing a grace period of coverage to allow consideration of referred health plan options or 18 |
|---|
| 359 | 359 | | establishment of medical necessity of the current course of treatment; 19 |
|---|
| 360 | 360 | | (B) Requiring continuity of care for medical services, including behavioral health services, 20 |
|---|
| 361 | 361 | | and prescription medications for patients on appropriate, chronic, stable therapy through 21 |
|---|
| 362 | 362 | | minimizing repetitive prior authorization requirements; and which for prescription medication shall 22 |
|---|
| 363 | 363 | | be allowed only on an annual review, with exception for labeled limitation, to establish continued 23 |
|---|
| 364 | 364 | | benefit of treatment; and 24 |
|---|
| 365 | 365 | | (C) Requiring communication between healthcare providers, health plans, and patients to 25 |
|---|
| 366 | 366 | | facilitate continuity of care and minimize disruptions in needed treatment which may be satisfied 26 |
|---|
| 367 | 367 | | by posting to provider-accessible websites or similar electronic portals or services; 27 |
|---|
| 368 | 368 | | (D) Continuity of care for formulary or drug coverage shall distinguish between FDA 28 |
|---|
| 369 | 369 | | designated interchangeable products and proprietary or marketed versions of a medication; 29 |
|---|
| 370 | 370 | | (ix) Encourage healthcare providers and/or provider organizations and health plans to 30 |
|---|
| 371 | 371 | | accelerate use of electronic prior authorization technology, including adoption of national standards 31 |
|---|
| 372 | 372 | | where applicable; and 32 |
|---|
| 373 | 373 | | (x) For the purposes of subsections (h)(3)(v) through (h)(3)(x) of this section, the 33 |
|---|
| 374 | 374 | | workgroup meeting may be conducted in part or whole through electronic methods. 34 |
|---|
| 375 | 375 | | |
|---|
| 376 | 376 | | |
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| 377 | 377 | | LC001524 - Page 11 of 16 |
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| 378 | 378 | | (4) To provide a report to the house and senate, on or before January 1, 2017, with 1 |
|---|
| 379 | 379 | | recommendations for establishing guidelines and regulations for systems that give patients 2 |
|---|
| 380 | 380 | | electronic access to their claims information, particularly to information regarding their obligations 3 |
|---|
| 381 | 381 | | to pay for received medical services, pursuant to 45 C.F.R. § 164.524. 4 |
|---|
| 382 | 382 | | (5) No provision of this subsection (h) shall preclude the ongoing work of the office of 5 |
|---|
| 383 | 383 | | health insurance commissioner’s administrative simplification task force, which includes meetings 6 |
|---|
| 384 | 384 | | with key stakeholders in order to improve, and provide recommendations regarding, the prior 7 |
|---|
| 385 | 385 | | authorization process. 8 |
|---|
| 386 | 386 | | (i) To issue an anti-cancer medication report. Not later than June 30, 2014, and annually 9 |
|---|
| 387 | 387 | | thereafter, the office of the health insurance commissioner (OHIC) shall provide the senate 10 |
|---|
| 388 | 388 | | committee on health and human services, and the house committee on corporations, with: (1) 11 |
|---|
| 389 | 389 | | Information on the availability in the commercial market of coverage for anti-cancer medication 12 |
|---|
| 390 | 390 | | options; (2) For the state employee’s health benefit plan, the costs of various cancer-treatment 13 |
|---|
| 391 | 391 | | options; (3) The changes in drug prices over the prior thirty-six (36) months; and (4) Member 14 |
|---|
| 392 | 392 | | utilization and cost-sharing expense. 15 |
|---|
| 393 | 393 | | (j) To monitor the adequacy of each health plan’s compliance with the provisions of the 16 |
|---|
| 394 | 394 | | federal Mental Health Parity Act, including a review of related claims processing and 17 |
|---|
| 395 | 395 | | reimbursement procedures. Findings, recommendations, and assessments shall be made available 18 |
|---|
| 396 | 396 | | to the public. 19 |
|---|
| 397 | 397 | | (k) To monitor the transition from fee-for-service and toward global and other alternative 20 |
|---|
| 398 | 398 | | payment methodologies for the payment for healthcare services. Alternative payment 21 |
|---|
| 399 | 399 | | methodologies should be assessed for their likelihood to promote access to affordable health 22 |
|---|
| 400 | 400 | | insurance, health outcomes, and performance. 23 |
|---|
| 401 | 401 | | (l) To report annually, no later than July 1, 2014, then biannually thereafter, on hospital 24 |
|---|
| 402 | 402 | | payment variation, including findings and recommendations, subject to available resources. 25 |
|---|
| 403 | 403 | | (m) Notwithstanding any provision of the general or public laws or regulation to the 26 |
|---|
| 404 | 404 | | contrary, provide a report with findings and recommendations to the president of the senate and the 27 |
|---|
| 405 | 405 | | speaker of the house, on or before April 1, 2014, including, but not limited to, the following 28 |
|---|
| 406 | 406 | | information: 29 |
|---|
| 407 | 407 | | (1) The impact of the current, mandated healthcare benefits as defined in §§ 27-18-48.1, 30 |
|---|
| 408 | 408 | | 27-18-60, 27-18-62, 27-18-64, similar provisions in chapters 19, 20 and 41 of title 27, and §§ 27-31 |
|---|
| 409 | 409 | | 18-3(c), 27-38.2-1 et seq., or others as determined by the commissioner, on the cost of health 32 |
|---|
| 410 | 410 | | insurance for fully insured employers, subject to available resources; 33 |
|---|
| 411 | 411 | | (2) Current provider and insurer mandates that are unnecessary and/or duplicative due to 34 |
|---|
| 412 | 412 | | |
|---|
| 413 | 413 | | |
|---|
| 414 | 414 | | LC001524 - Page 12 of 16 |
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| 415 | 415 | | the existing standards of care and/or delivery of services in the healthcare system; 1 |
|---|
| 416 | 416 | | (3) A state-by-state comparison of health insurance mandates and the extent to which 2 |
|---|
| 417 | 417 | | Rhode Island mandates exceed other states benefits; and 3 |
|---|
| 418 | 418 | | (4) Recommendations for amendments to existing mandated benefits based on the findings 4 |
|---|
| 419 | 419 | | in (m)(1), (m)(2), and (m)(3) above. 5 |
|---|
| 420 | 420 | | (n) On or before July 1, 2014, the office of the health insurance commissioner, in 6 |
|---|
| 421 | 421 | | collaboration with the director of health and lieutenant governor’s office, shall submit a report to 7 |
|---|
| 422 | 422 | | the general assembly and the governor to inform the design of accountable care organizations 8 |
|---|
| 423 | 423 | | (ACOs) in Rhode Island as unique structures for comprehensive healthcare delivery and value-9 |
|---|
| 424 | 424 | | based payment arrangements, that shall include, but not be limited to: 10 |
|---|
| 425 | 425 | | (1) Utilization review; 11 |
|---|
| 426 | 426 | | (2) Contracting; and 12 |
|---|
| 427 | 427 | | (3) Licensing and regulation. 13 |
|---|
| 428 | 428 | | (o) On or before February 3, 2015, the office of the health insurance commissioner shall 14 |
|---|
| 429 | 429 | | submit a report to the general assembly and the governor that describes, analyzes, and proposes 15 |
|---|
| 430 | 430 | | recommendations to improve compliance of insurers with the provisions of § 27-18-76 with regard 16 |
|---|
| 431 | 431 | | to patients with mental health and substance use disorders. 17 |
|---|
| 432 | 432 | | (p) To work to ensure the health insurance coverage of behavioral health care under the 18 |
|---|
| 433 | 433 | | same terms and conditions as other health care, and to integrate behavioral health parity 19 |
|---|
| 434 | 434 | | requirements into the office of the health insurance commissioner insurance oversight and 20 |
|---|
| 435 | 435 | | healthcare transformation efforts. 21 |
|---|
| 436 | 436 | | (q) To work with other state agencies to seek delivery system improvements that enhance 22 |
|---|
| 437 | 437 | | access to a continuum of mental health and substance use disorder treatment in the state; and 23 |
|---|
| 438 | 438 | | integrate that treatment with primary and other medical care to the fullest extent possible. 24 |
|---|
| 439 | 439 | | (r) To direct insurers toward policies and practices that address the behavioral health needs 25 |
|---|
| 440 | 440 | | of the public and greater integration of physical and behavioral healthcare delivery. 26 |
|---|
| 441 | 441 | | (s) The office of the health insurance commissioner shall conduct an analysis of the impact 27 |
|---|
| 442 | 442 | | of the provisions of § 27-38.2-1(i) on health insurance premiums and access in Rhode Island and 28 |
|---|
| 443 | 443 | | submit a report of its findings to the general assembly on or before June 1, 2023. 29 |
|---|
| 444 | 444 | | (t) To undertake the analyses, reports, and studies contained in this section: 30 |
|---|
| 445 | 445 | | (1) The office shall hire the necessary staff and prepare a request for proposal for a qualified 31 |
|---|
| 446 | 446 | | and competent firm or firms to undertake the following analyses, reports, and studies: 32 |
|---|
| 447 | 447 | | (i) The firm shall undertake a comprehensive review of all social and human service 33 |
|---|
| 448 | 448 | | programs having a contract with or licensed by the state or any subdivision of the department of 34 |
|---|
| 449 | 449 | | |
|---|
| 450 | 450 | | |
|---|
| 451 | 451 | | LC001524 - Page 13 of 16 |
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| 452 | 452 | | children, youth and families (DCYF), the department of behavioral healthcare, developmental 1 |
|---|
| 453 | 453 | | disabilities and hospitals (BHDDH), the department of human services (DHS), the department of 2 |
|---|
| 454 | 454 | | health (DOH), and Medicaid for the purposes of: 3 |
|---|
| 455 | 455 | | (A) Establishing a baseline of the eligibility factors for receiving services; 4 |
|---|
| 456 | 456 | | (B) Establishing a baseline of the service offering through each agency for those 5 |
|---|
| 457 | 457 | | determined eligible; 6 |
|---|
| 458 | 458 | | (C) Establishing a baseline understanding of reimbursement rates for all social and human 7 |
|---|
| 459 | 459 | | service programs including rates currently being paid, the date of the last increase, and a proposed 8 |
|---|
| 460 | 460 | | model that the state may use to conduct future studies and analyses; 9 |
|---|
| 461 | 461 | | (D) Ensuring accurate and adequate reimbursement to social and human service providers 10 |
|---|
| 462 | 462 | | that facilitate the availability of high-quality services to individuals receiving home and 11 |
|---|
| 463 | 463 | | community-based long-term services and supports provided by social and human service providers; 12 |
|---|
| 464 | 464 | | (E) Ensuring the general assembly is provided accurate financial projections on social and 13 |
|---|
| 465 | 465 | | human service program costs, demand for services, and workforce needs to ensure access to entitled 14 |
|---|
| 466 | 466 | | beneficiaries and services; 15 |
|---|
| 467 | 467 | | (F) Establishing a baseline and determining the relationship between state government and 16 |
|---|
| 468 | 468 | | the provider network including functions, responsibilities, and duties; 17 |
|---|
| 469 | 469 | | (G) Determining a set of measures and accountability standards to be used by EOHHS and 18 |
|---|
| 470 | 470 | | the general assembly to measure the outcomes of the provision of services including budgetary 19 |
|---|
| 471 | 471 | | reporting requirements, transparency portals, and other methods; and 20 |
|---|
| 472 | 472 | | (H) Reporting the findings of human services analyses and reports to the speaker of the 21 |
|---|
| 473 | 473 | | house, senate president, chairs of the house and senate finance committees, chairs of the house and 22 |
|---|
| 474 | 474 | | senate health and human services committees, and the governor. 23 |
|---|
| 475 | 475 | | (2) The analyses, reports, and studies required pursuant to this section shall be 24 |
|---|
| 476 | 476 | | accomplished and published as follows and shall provide: 25 |
|---|
| 477 | 477 | | (i) An assessment and detailed reporting on all social and human service program rates to 26 |
|---|
| 478 | 478 | | be completed by January 1, 2023, including rates currently being paid and the date of the last 27 |
|---|
| 479 | 479 | | increase; 28 |
|---|
| 480 | 480 | | (ii) An assessment and detailed reporting on eligibility standards and processes of all 29 |
|---|
| 481 | 481 | | mandatory and discretionary social and human service programs to be completed by January 1, 30 |
|---|
| 482 | 482 | | 2023; 31 |
|---|
| 483 | 483 | | (iii) An assessment and detailed reporting on utilization trends from the period of January 32 |
|---|
| 484 | 484 | | 1, 2017, through December 31, 2021, for social and human service programs to be completed by 33 |
|---|
| 485 | 485 | | January 1, 2023; 34 |
|---|
| 486 | 486 | | |
|---|
| 487 | 487 | | |
|---|
| 488 | 488 | | LC001524 - Page 14 of 16 |
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| 489 | 489 | | (iv) An assessment and detailed reporting on the structure of the state government as it 1 |
|---|
| 490 | 490 | | relates to the provision of services by social and human service providers including eligibility and 2 |
|---|
| 491 | 491 | | functions of the provider network to be completed by January 1, 2023; 3 |
|---|
| 492 | 492 | | (v) An assessment and detailed reporting on accountability standards for services for social 4 |
|---|
| 493 | 493 | | and human service programs to be completed by January 1, 2023; 5 |
|---|
| 494 | 494 | | (vi) An assessment and detailed reporting by April 1, 2023, on all professional licensed 6 |
|---|
| 495 | 495 | | and unlicensed personnel requirements for established rates for social and human service programs 7 |
|---|
| 496 | 496 | | pursuant to a contract or established fee schedule; 8 |
|---|
| 497 | 497 | | (vii) An assessment and reporting on access to social and human service programs, to 9 |
|---|
| 498 | 498 | | include any wait lists and length of time on wait lists, in each service category by April 1, 2023; 10 |
|---|
| 499 | 499 | | (viii) An assessment and reporting of national and regional Medicaid rates in comparison 11 |
|---|
| 500 | 500 | | to Rhode Island social and human service provider rates by April 1, 2023; 12 |
|---|
| 501 | 501 | | (ix) An assessment and reporting on usual and customary rates paid by private insurers and 13 |
|---|
| 502 | 502 | | private pay for similar social and human service providers, both nationally and regionally, by April 14 |
|---|
| 503 | 503 | | 1, 2023; and 15 |
|---|
| 504 | 504 | | (x) Completion of the development of an assessment and review process that includes the 16 |
|---|
| 505 | 505 | | following components: eligibility; scope of services; relationship of social and human service 17 |
|---|
| 506 | 506 | | provider and the state; national and regional rate comparisons and accountability standards that 18 |
|---|
| 507 | 507 | | result in recommended rate adjustments; and this process shall be completed by September 1, 2023, 19 |
|---|
| 508 | 508 | | and conducted biennially hereafter. The biennial rate setting shall be consistent with payment 20 |
|---|
| 509 | 509 | | requirements established in § 1902(a)(30)(A) of the Social Security Act, 42 U.S.C. § 21 |
|---|
| 510 | 510 | | 1396a(a)(30)(A), and all federal and state law, regulations, and quality and safety standards. The 22 |
|---|
| 511 | 511 | | results and findings of this process shall be transparent, and public meetings shall be conducted to 23 |
|---|
| 512 | 512 | | allow providers, recipients, and other interested parties an opportunity to ask questions and provide 24 |
|---|
| 513 | 513 | | comment beginning in September 2023 and biennially thereafter. 25 |
|---|
| 514 | 514 | | (3) In fulfillment of the responsibilities defined in subsection (t), the office of the health 26 |
|---|
| 515 | 515 | | insurance commissioner shall consult with the Executive Office of Health and Human Services. 27 |
|---|
| 516 | 516 | | (u) Annually, each department (namely, EOHHS, DCYF, DOH, DHS, and BHDDH) shall 28 |
|---|
| 517 | 517 | | include the corresponding components of the assessment and review (i.e., eligibility; scope of 29 |
|---|
| 518 | 518 | | services; relationship of social and human service provider and the state; and national and regional 30 |
|---|
| 519 | 519 | | rate comparisons and accountability standards including any changes or substantive issues between 31 |
|---|
| 520 | 520 | | biennial reviews) including the recommended rates from the most recent assessment and review 32 |
|---|
| 521 | 521 | | with their annual budget submission to the office of management and budget and provide a detailed 33 |
|---|
| 522 | 522 | | explanation and impact statement if any rate variances exist between submitted recommended 34 |
|---|
| 523 | 523 | | |
|---|
| 524 | 524 | | |
|---|
| 525 | 525 | | LC001524 - Page 15 of 16 |
|---|
| 526 | 526 | | budget and the corresponding recommended rate from the most recent assessment and review 1 |
|---|
| 527 | 527 | | process starting October 1, 2023, and biennially thereafter. 2 |
|---|
| 528 | 528 | | (v) The office of health insurance commissioner shall promulgate rules and regulations, 3 |
|---|
| 529 | 529 | | and employ staff and independent contractors familiar with pharmacy benefit managers’ operations 4 |
|---|
| 530 | 530 | | and finances, to implement and enforce the provisions of § 27-29.1-7(b) and may impose civil fines 5 |
|---|
| 531 | 531 | | up to ten thousand dollars ($10,000) per violation, or take any other enforcement action not 6 |
|---|
| 532 | 532 | | prohibited by law. This section does not limit the attorney general from taking any actions against 7 |
|---|
| 533 | 533 | | pharmacy benefit managers. Should any provision of this section be found unconstitutional, 8 |
|---|
| 534 | 534 | | preempted, or otherwise invalid, that provision shall be severed and such decision shall not affect 9 |
|---|
| 535 | 535 | | the validity of other parts of this section. OHIC shall consult with the EOHHS, the commissioner 10 |
|---|
| 536 | 536 | | of insurance, the department of business regulation, and other state authorities to ensure effective 11 |
|---|
| 537 | 537 | | pharmacy benefit manager oversight. 12 |
|---|
| 538 | 538 | | (v)(w) The general assembly shall appropriate adequate funding as it deems necessary to 13 |
|---|
| 539 | 539 | | undertake the analyses, reports, and studies contained in this section relating to the powers and 14 |
|---|
| 540 | 540 | | duties of the office of the health insurance commissioner. 15 |
|---|
| 541 | 541 | | SECTION 5. This act shall take effect upon passage. 16 |
|---|
| 542 | 542 | | ======== |
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| 543 | 543 | | LC001524 |
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| 544 | 544 | | ======== |
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| 545 | 545 | | |
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| 546 | 546 | | |
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| 547 | 547 | | LC001524 - Page 16 of 16 |
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| 548 | 548 | | EXPLANATION |
|---|
| 549 | 549 | | BY THE LEGISLATIVE COUNCIL |
|---|
| 550 | 550 | | OF |
|---|
| 551 | 551 | | A N A C T |
|---|
| 552 | 552 | | RELATING TO INSURANCE -- THIRD-PARTY HEALTH INSURANCE |
|---|
| 553 | 553 | | ADMINISTRATORS -- PRESCRIPTION DRUG COST CONTROL AND TRANSPARENCY |
|---|
| 554 | 554 | | *** |
|---|
| 555 | 555 | | This act would provide certain controls over prescription drug costs by imposing transparency, 1 |
|---|
| 556 | 556 | | oversight and accountability requirements on commercial insurers and their pharmacy benefit managers 2 |
|---|
| 557 | 557 | | (PBMs). 3 |
|---|
| 558 | 558 | | This act would take effect upon passage. 4 |
|---|
| 559 | 559 | | ======== |
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| 560 | 560 | | LC001524 |
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| 561 | 561 | | ======== |
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