Prohibits health insurance plans from requiring prior authorization for a new episode of rehabilitative care for twelve visits, or from requiring prior authorization for rehabilitative care for chronic pain for ninety days.
Impact
If enacted, H5623 would significantly impact state laws governing health insurance practices. It mandates that health insurance providers respond promptly to prior authorization requests, specifically within twenty-four hours. Moreover, any failure by an insurance company to process a prior authorization request within the stipulated timeframe would result in the authorization being deemed approved. This could lead to a reduction in the administrative burdens faced by healthcare providers and patients, enhancing the efficiency of care delivery for rehabilitative treatments.
Summary
House Bill 5623 seeks to amend the laws concerning health insurance related to rehabilitative and habilitative services in Rhode Island. The bill primarily prohibits insurance plans from requiring prior authorization for up to twelve visits in a new episode of rehabilitative care or for ninety days of rehabilitative care for individuals suffering from chronic pain. By doing this, the bill aims to streamline access to necessary therapeutic services for patients, establishing clearer protocols for health insurance providers to follow when processing treatment requests.
Contention
While the bill aims to enhance access to healthcare services, it may face scrutiny regarding its implications for insurance companies' operational guidelines. Advocates for the bill argue that removing prior authorization requirements boosts patient access and alleviates delays in receiving crucial therapies. Nonetheless, some stakeholders in the insurance sector could contend that such measures may lead to increased financial liabilities for insurance companies, arguing that it could complicate financial assessments of service necessity and lead to potential over-utilization of services.
Defines step therapy and prohibits certain groups and agreements from requiring prior authorization or a step therapy protocol when prescribing certain medications.
Prohibits prior authorization or a step therapy protocol for the prescription of a nonpreferred medication on their drug formulary used to assess or treat an enrollee's bipolar disorder, schizophrenia or schizotypal.
Requires insurance coverage for at a minimum up to ninety (90) days of residential or inpatient services for mental health and/or substance use disorders for American Society of Addiction Medicine levels of care 3.1 and 3.3.
Requires insurance coverage for at a minimum up to ninety (90) days of residential or inpatient services for mental health and/or substance use disorders for American Society of Addiction Medicine levels of care 3.1 and 3.3.
Eliminates prior authorization or step therapy requirement for prescriptions for any HIV prevention drug/prohibits the requirement of any copayment or the meeting of any deductible to obtain the prescription covered by the contract, plan, or policy.
Eliminates prior authorization or step therapy requirement for prescriptions for any HIV prevention drug/prohibits the requirement of any copayment or the meeting of any deductible to obtain the prescription covered by the contract, plan, or policy.