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| 5 | 5 | | 2025 -- H 5851 |
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| 6 | 6 | | ======== |
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| 7 | 7 | | LC001653 |
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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 -- CONTRACT WITH HEALTHCARE PROVIDERS |
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| 16 | 16 | | Introduced By: Representatives Morales, Stewart, Felix, Tanzi, Handy, Cruz, Potter, and |
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| 17 | 17 | | Caldwell |
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| 18 | 18 | | Date Introduced: February 28, 2025 |
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| 19 | 19 | | Referred To: House Health & Human Services |
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| 20 | 20 | | |
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| 21 | 21 | | |
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| 22 | 22 | | It is enacted by the General Assembly as follows: |
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| 23 | 23 | | SECTION 1. Section 27-20.9-3 of the General Laws in Chapter 27-20.9 entitled "Contract 1 |
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| 24 | 24 | | with Healthcare Providers" is hereby amended to read as follows: 2 |
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| 25 | 25 | | 27-20.9-3. Pay-for-performance guidelines. 3 |
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| 26 | 26 | | A health insurer shall not require a physician, as a condition of contracting, to participate 4 |
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| 27 | 27 | | in any financial or reimbursement incentive program, commonly referred to as pay-for-5 |
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| 28 | 28 | | performance programs, unless such program meets the principles and guidelines for pay-for-6 |
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| 29 | 29 | | performance programs endorsed by the national quality forum and adopted by the AQA Alliance 7 |
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| 30 | 30 | | or the hospital quality alliance, or similar principles and guidelines for pay-for-performance 8 |
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| 31 | 31 | | programs approved by the office of the health insurance commissioner "capitation," or any other 9 |
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| 32 | 32 | | "alternative payment model" that creates a financial incentive for a physician to limit medically 10 |
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| 33 | 33 | | necessary care or to choose to keep low need patients or not to keep high need patients. 11 |
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| 34 | 34 | | SECTION 2. This act shall take effect upon passage. 12 |
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| 35 | 35 | | ======== |
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| 36 | 36 | | LC001653 |
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| 37 | 37 | | ======== |
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| 38 | 38 | | |
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| 39 | 39 | | |
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| 40 | 40 | | LC001653 - Page 2 of 2 |
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| 41 | 41 | | EXPLANATION |
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| 42 | 42 | | BY THE LEGISLATIVE COUNCIL |
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| 43 | 43 | | OF |
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| 44 | 44 | | A N A C T |
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| 45 | 45 | | RELATING TO INSURANCE -- CONTRACT WITH HEALTHCARE PROVIDERS |
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| 46 | 46 | | *** |
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| 47 | 47 | | This act would amend the current law in order that a health insurer would not require a 1 |
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| 48 | 48 | | physician, as a condition of contracting, to participate in any financial or reimbursement incentive 2 |
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| 49 | 49 | | program, commonly referred to as "capitation," or any other "alternative payment model" that 3 |
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| 50 | 50 | | creates a financial incentive for a physician to limit medically necessary care or to choose to keep 4 |
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| 51 | 51 | | low need patients or not to keep high need patients. 5 |
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| 52 | 52 | | This act would take effect upon passage. 6 |
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| 53 | 53 | | ======== |
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| 54 | 54 | | LC001653 |
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| 55 | 55 | | ======== |
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