Rhode Island 2025 Regular Session

Rhode Island House Bill H5623

Introduced
2/26/25  

Caption

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.

Companion Bills

No companion bills found.

Previously Filed As

RI H5628

Mandates all health insurance contracts, plans, or policies provide the same reimbursement to independent healthcare facilities as that of hospital affiliated facilities where the same healthcare service is provided.

RI H5082

Limits copays, coinsurance or office deductibles for services of a physical therapist to the amount authorized for the services of a primary care physician or osteopath on or after January 1, 2026.

RI S0051

Limits copays, coinsurance or office deductibles for services of a physical therapist to the amount authorized for the services of a primary care physician or osteopath on or after January 1, 2026.

RI H6158

Mandates insurance coverage for scalp cooling treatments for breast cancer patients undergoing chemotherapy to prevent hair loss during chemotherapy treatments.

RI S0263

Requires coverage for acute mental health crisis mobile response and stabilization services to eligible individuals enrolled as plan beneficiaries.

RI H6118

Requires coverage for acute mental health crisis mobile response and stabilization services to eligible individuals enrolled as plan beneficiaries.

RI S0115

Requires health plans that provide prescription benefits to cover at least one type of glucagon auto-injector, nasal spray, or formulation that does not require reconstitution to treat hypoglycemia. No copayment or deductible would be required.

RI H5173

Requires health plans that provide prescription benefits to cover at least one type of glucagon auto-injector, nasal spray, or formulation that does not require reconstitution to treat hypoglycemia. No copayment or deductible would be required.

Similar Bills

CA AB517

Medi-Cal: complex rehabilitation technology: wheelchairs.

HI HB1263

Relating To Corrections.

DC B25-0826

Recidivism Reduction, Oversight, and Accountability for DYRS Act of 2024 (ROAD Act)

MA H1218

Relative to access to health care

HI HB251

Relating To Social Work.

HI SB734

Relating To Social Work.

MA H1278

Relative to wheelchair repair requirements and consumer protection

RI S0485

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.