Rhode Island Senate Bill S0485

Rhode Island 2025 Regular Session

• Introduced: 2/26/25
• Refer: 2/26/25

Caption

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.

Impact

In addition, the bill allows patients with chronic pain to avoid prior authorization for the first ninety days post-diagnosis, thereby facilitating timely access to necessary nonpharmacologic management. This change aims to ease the burden often placed on patients receiving rehabilitation services by streamlining the process for obtaining care, with a focus on enhancing patient experience and outcomes. Moreover, if a health insurance plan fails to respond to prior authorization requests in a timely manner, the requests may be automatically approved.

Summary

Bill S0485, Introduced in the Rhode Island General Assembly, aims to modify the current health insurance policies regarding prior authorization requirements for rehabilitative and habilitative services. The legislation stipulates that individual or group health insurance plans will not require prior authorization for rehabilitative or habilitative services for the first twelve visits of a new episode of care. A 'new episode of care' is defined as treatment for a new or recurring condition for which the patient has not received care within the last ninety days.

Contention

While supporters of S0485 argue that these amendments will improve access to vital therapies for patients, particularly those dealing with chronic pain, there may be concerns regarding insurers' financial implications. Critics may express apprehensions that reducing prior authorization oversight could lead to increased costs or potential overuse of services. Moreover, the balance between ensuring necessary care and managing healthcare costs consistently raises debates within legislative discussions regarding health policy reforms.