2025 -- H 5851
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LC001653
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S T A T E O F R H O D E I S L A N D
IN GENERAL ASSEMBLY
JANUARY SESSION, A.D. 2025
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A N A C T
RELATING TO INSURANCE -- CONTRACT WITH HEALTHCARE PROVIDERS
Introduced By: Representatives Morales, Stewart, Felix, Tanzi, Handy, Cruz, Potter, and
Caldwell
Date Introduced: February 28, 2025
Referred To: House Health & Human Services
It is enacted by the General Assembly as follows:
SECTION 1. Section 27-20.9-3 of the General Laws in Chapter 27-20.9 entitled "Contract 1
with Healthcare Providers" is hereby amended to read as follows: 2
27-20.9-3. Pay-for-performance guidelines. 3
A health insurer shall not require a physician, as a condition of contracting, to participate 4
in any financial or reimbursement incentive program, commonly referred to as pay-for-5
performance programs, unless such program meets the principles and guidelines for pay-for-6
performance programs endorsed by the national quality forum and adopted by the AQA Alliance 7
or the hospital quality alliance, or similar principles and guidelines for pay-for-performance 8
programs approved by the office of the health insurance commissioner "capitation," or any other 9
"alternative payment model" that creates a financial incentive for a physician to limit medically 10
necessary care or to choose to keep low need patients or not to keep high need patients. 11
SECTION 2. This act shall take effect upon passage. 12
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LC001653 - Page 2 of 2
EXPLANATION
BY THE LEGISLATIVE COUNCIL
OF
A N A C T
RELATING TO INSURANCE -- CONTRACT WITH HEALTHCARE PROVIDERS
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This act would amend the current law in order that a health insurer would not require a 1
physician, as a condition of contracting, to participate in any financial or reimbursement incentive 2
program, commonly referred to as "capitation," or any other "alternative payment model" that 3
creates a financial incentive for a physician to limit medically necessary care or to choose to keep 4
low need patients or not to keep high need patients. 5
This act would take effect upon passage. 6
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