RI
Rhode Island House Bill H6317

Rhode Island 2025 Regular Session

Rhode Island House Bill H6317

Introduced
5/9/25  

Caption

Prohibits an insurer from imposing a requirement of prior authorization for any admission, item, service, treatment, test, exam, study, procedure, or any generic or brand name prescription drug ordered by a primary care provider.

Impact

The intended impact of H6317 is to enhance patient access to care by limiting unnecessary delays caused by prior authorization requirements. By mandating the use of a single, standardized prior authorization form, the bill aims to simplify processes for both healthcare providers and insurers. This change is expected to alleviate burdens on primary care providers who often struggle with the complex and varied authorization processes currently in place, potentially leading to improved continuity of care and patient satisfaction.

Summary

House Bill 6317 aims to reform the prior authorization process within health insurance by prohibiting insurers from imposing prior authorization requirements for any services ordered by primary care providers. This restriction covers a wide range of admissions, treatments, tests, and prescription drugs, with exceptions primarily focused on controlled substances and cases of documented fraud, waste, or abuse. The bill seeks to streamline healthcare access by reducing administrative barriers that often delay necessary medical procedures.

Contention

Despite its aims to provide better access to healthcare, H6317 has garnered contention from stakeholders concerned about the potential challenges of limiting prior authorizations. Opponents argue that prior authorization is a necessary tool for ensuring that medical services are appropriate and cost-effective. They worry that decreasing the requirements may lead to increased healthcare costs and possible overutilization of services. Furthermore, discussions around the exceptions for controlled substances point to the ongoing concerns about compliance and oversight within the healthcare landscape.

Companion Bills

No companion bills found.

Previously Filed As

RI S2611

Limits the use by insurers of step therapy, a protocol that establishes a specific sequence in which prescription drugs for a specified medical condition are covered by an insurer, by allowing medical providers to request step therapy exceptions.

RI H7822

Limits the use by insurers of step therapy, a protocol that establishes a specific sequence in which prescription drugs for a specified medical condition are covered by an insurer, by allowing medical providers to request step therapy exceptions.

RI H7625

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.

RI S2255

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.

RI S2614

Requires a report to be produced that focuses on prescription drug prior authorizations by January 1, 2025.

RI H7623

Requires a report to be produced that focuses on prescription drug prior authorizations by January 1, 2025.

RI S2723

Includes the definition of "primary care services" and requires that all biennial reports shall include a review and recommendation of rates for primary care services on and after September 1, 2025.

RI H7043

Prohibits health benefit plans reviewing prescriptions for opioid addiction treatment.

RI S2177

Prohibits health benefit plans reviewing prescriptions for opioid addiction treatment.

RI H7737

Prohibits an insurance company from imposing any cost-sharing requirements for any diagnostic or supplemental breast examinations.

Similar Bills

RI S0053

Provides an insurer would not impose prior authorization requirements for any service ordered by an in-network primary care provider.

RI H5120

Provides an insurer would not impose prior authorization requirements for any service ordered by an in-network primary care provider.

RI S0168

Provides an insurer would not impose prior authorization requirements for any service ordered by an in-network primary care provider.

RI H5172

Would promote transparency and accountability in the use of artificial intelligence by health insurers to manage coverage and claims.

RI S0013

Promotes transparency and accountability in the use of artificial intelligence by health insurers to manage coverage and claims.

RI H5119

Limits the use by insurers of step therapy, a protocol that establishes a specific sequence in which prescription drugs for a specified medical condition are covered by an insurer, by allowing medical providers to request step therapy exceptions.

RI S0116

Limits the use by insurers of step therapy, a protocol that establishes a specific sequence in which prescription drugs for a specified medical condition are covered by an insurer, by allowing medical providers to request step therapy exceptions.

RI S2611

Limits the use by insurers of step therapy, a protocol that establishes a specific sequence in which prescription drugs for a specified medical condition are covered by an insurer, by allowing medical providers to request step therapy exceptions.