2025 -- S 0681
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LC002075
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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
____________
A N A C T
RELATING TO STATE AFFAIRS AND GOVERNMENT -- THE RHODE ISLAND HEALTH
CARE REFORM ACT OF 2004 -- HEALTH INSURANCE OVERSIGHT
Introduced By: Senators Sosnowski, Murray, Lauria, Bissaillon, Burke, and Pearson
Date Introduced: March 07, 2025
Referred To: Senate Health & Human Services
It is enacted by the General Assembly as follows:
SECTION 1. Section 42-14.5-3 of the General Laws in Chapter 42-14.5 entitled "The 1
Rhode Island Health Care Reform Act of 2004 — Health Insurance Oversight" is hereby amended 2
to read as follows: 3
42-14.5-3. Powers and duties. 4
The health insurance commissioner shall have the following powers and duties: 5
(a) To conduct quarterly public meetings throughout the state, separate and distinct from 6
rate hearings pursuant to § 42-62-13, regarding the rates, services, and operations of insurers 7
licensed to provide health insurance in the state; the effects of such rates, services, and operations 8
on consumers, medical care providers, patients, and the market environment in which the insurers 9
operate; and efforts to bring new health insurers into the Rhode Island market. Notice of not less 10
than ten (10) days of the hearing(s) shall go to the general assembly, the governor, the Rhode Island 11
Medical Society, the Hospital Association of Rhode Island, the director of health, the attorney 12
general, and the chambers of commerce. Public notice shall be posted on the department’s website 13
and given in the newspaper of general circulation, and to any entity in writing requesting notice. 14
(b) To make recommendations to the governor and the house of representatives and senate 15
finance committees regarding healthcare insurance and the regulations, rates, services, 16
administrative expenses, reserve requirements, and operations of insurers providing health 17
insurance in the state, and to prepare or comment on, upon the request of the governor or 18
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chairpersons of the house or senate finance committees, draft legislation to improve the regulation 1
of health insurance. In making the recommendations, the commissioner shall recognize that it is 2
the intent of the legislature that the maximum disclosure be provided regarding the reasonableness 3
of individual administrative expenditures as well as total administrative costs. The commissioner 4
shall make recommendations on the levels of reserves, including consideration of: targeted reserve 5
levels; trends in the increase or decrease of reserve levels; and insurer plans for distributing excess 6
reserves. 7
(c) To establish a consumer/business/labor/medical advisory council to obtain information 8
and present concerns of consumers, business, and medical providers affected by health insurance 9
decisions. The council shall develop proposals to allow the market for small business health 10
insurance to be affordable and fairer. The council shall be involved in the planning and conduct of 11
the quarterly public meetings in accordance with subsection (a). The advisory council shall develop 12
measures to inform small businesses of an insurance complaint process to ensure that small 13
businesses that experience rate increases in a given year may request and receive a formal review 14
by the department. The advisory council shall assess views of the health provider community 15
relative to insurance rates of reimbursement, billing, and reimbursement procedures, and the 16
insurers’ role in promoting efficient and high-quality health care. The advisory council shall issue 17
an annual report of findings and recommendations to the governor and the general assembly and 18
present its findings at hearings before the house and senate finance committees. The advisory 19
council is to be diverse in interests and shall include representatives of community consumer 20
organizations; small businesses, other than those involved in the sale of insurance products; and 21
hospital, medical, and other health provider organizations. Such representatives shall be nominated 22
by their respective organizations. The advisory council shall be co-chaired by the health insurance 23
commissioner and a community consumer organization or small business member to be elected by 24
the full advisory council. 25
(d) To establish and provide guidance and assistance to a subcommittee (“the professional-26
provider-health-plan work group”) of the advisory council created pursuant to subsection (c), 27
composed of healthcare providers and Rhode Island licensed health plans. This subcommittee shall 28
include in its annual report and presentation before the house and senate finance committees the 29
following information: 30
(1) A method whereby health plans shall disclose to contracted providers the fee schedules 31
used to provide payment to those providers for services rendered to covered patients; 32
(2) A standardized provider application and credentials verification process, for the 33
purpose of verifying professional qualifications of participating healthcare providers; 34
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(3) The uniform health plan claim form utilized by participating providers; 1
(4) Methods for health maintenance organizations, as defined by § 27-41-2, and nonprofit 2
hospital or medical service corporations, as defined by chapters 19 and 20 of title 27, to make 3
facility-specific data and other medical service-specific data available in reasonably consistent 4
formats to patients regarding quality and costs. This information would help consumers make 5
informed choices regarding the facilities and clinicians or physician practices at which to seek care. 6
Among the items considered would be the unique health services and other public goods provided 7
by facilities and clinicians or physician practices in establishing the most appropriate cost 8
comparisons; 9
(5) All activities related to contractual disclosure to participating providers of the 10
mechanisms for resolving health plan/provider disputes; 11
(6) The uniform process being utilized for confirming, in real time, patient insurance 12
enrollment status, benefits coverage, including copays and deductibles; 13
(7) Information related to temporary credentialing of providers seeking to participate in the 14
plan’s network and the impact of the activity on health plan accreditation; 15
(8) The feasibility of regular contract renegotiations between plans and the providers in 16
their networks; and 17
(9) Efforts conducted related to reviewing impact of silent PPOs on physician practices. 18
(e) To enforce the provisions of title 27 and title 42 as set forth in § 42-14-5(d). 19
(f) To provide analysis of the Rhode Island affordable health plan reinsurance fund. The 20
fund shall be used to effectuate the provisions of §§ 27-18.5-9 and 27-50-17. 21
(g) To analyze the impact of changing the rating guidelines and/or merging the individual 22
health insurance market, as defined in chapter 18.5 of title 27, and the small-employer health 23
insurance market, as defined in chapter 50 of title 27, in accordance with the following: 24
(1) The analysis shall forecast the likely rate increases required to effect the changes 25
recommended pursuant to the preceding subsection (g) in the direct-pay market and small-employer 26
health insurance market over the next five (5) years, based on the current rating structure and 27
current products. 28
(2) The analysis shall include examining the impact of merging the individual and small-29
employer markets on premiums charged to individuals and small-employer groups. 30
(3) The analysis shall include examining the impact on rates in each of the individual and 31
small-employer health insurance markets and the number of insureds in the context of possible 32
changes to the rating guidelines used for small-employer groups, including: community rating 33
principles; expanding small-employer rate bonds beyond the current range; increasing the employer 34
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group size in the small-group market; and/or adding rating factors for broker and/or tobacco use. 1
(4) The analysis shall include examining the adequacy of current statutory and regulatory 2
oversight of the rating process and factors employed by the participants in the proposed, new 3
merged market. 4
(5) The analysis shall include assessment of possible reinsurance mechanisms and/or 5
federal high-risk pool structures and funding to support the health insurance market in Rhode Island 6
by reducing the risk of adverse selection and the incremental insurance premiums charged for this 7
risk, and/or by making health insurance affordable for a selected at-risk population. 8
(6) The health insurance commissioner shall work with an insurance market merger task 9
force to assist with the analysis. The task force shall be chaired by the health insurance 10
commissioner and shall include, but not be limited to, representatives of the general assembly, the 11
business community, small-employer carriers as defined in § 27-50-3, carriers offering coverage in 12
the individual market in Rhode Island, health insurance brokers, and members of the general public. 13
(7) For the purposes of conducting this analysis, the commissioner may contract with an 14
outside organization with expertise in fiscal analysis of the private insurance market. In conducting 15
its study, the organization shall, to the extent possible, obtain and use actual health plan data. Said 16
data shall be subject to state and federal laws and regulations governing confidentiality of health 17
care and proprietary information. 18
(8) The task force shall meet as necessary and include its findings in the annual report, and 19
the commissioner shall include the information in the annual presentation before the house and 20
senate finance committees. 21
(h) To establish and convene a workgroup representing healthcare providers and health 22
insurers for the purpose of coordinating the development of processes, guidelines, and standards to 23
streamline healthcare administration that are to be adopted by payors and providers of healthcare 24
services operating in the state. This workgroup shall include representatives with expertise who 25
would contribute to the streamlining of healthcare administration and who are selected from 26
hospitals, physician practices, community behavioral health organizations, each health insurer, and 27
other affected entities. The workgroup shall also include at least one designee each from the Rhode 28
Island Medical Society, Rhode Island Council of Community Mental Health Organizations, the 29
Rhode Island Health Center Association, and the Hospital Association of Rhode Island. In any year 30
that the workgroup meets and submits recommendations to the office of the health insurance 31
commissioner, the office of the health insurance commissioner shall submit such recommendations 32
to the health and human services committees of the Rhode Island house of representatives and the 33
Rhode Island senate prior to the implementation of any such recommendations and subsequently 34
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shall submit a report to the general assembly by June 30, 2024. The report shall include the 1
recommendations the commissioner may implement, with supporting rationale. The workgroup 2
shall consider and make recommendations for: 3
(1) Establishing a consistent standard for electronic eligibility and coverage verification. 4
Such standard shall: 5
(i) Include standards for eligibility inquiry and response and, wherever possible, be 6
consistent with the standards adopted by nationally recognized organizations, such as the Centers 7
for Medicare & Medicaid Services; 8
(ii) Enable providers and payors to exchange eligibility requests and responses on a system-9
to-system basis or using a payor-supported web browser; 10
(iii) Provide reasonably detailed information on a consumer’s eligibility for healthcare 11
coverage; scope of benefits; limitations and exclusions provided under that coverage; cost-sharing 12
requirements for specific services at the specific time of the inquiry; current deductible amounts; 13
accumulated or limited benefits; out-of-pocket maximums; any maximum policy amounts; and 14
other information required for the provider to collect the patient’s portion of the bill; 15
(iv) Reflect the necessary limitations imposed on payors by the originator of the eligibility 16
and benefits information; 17
(v) Recommend a standard or common process to protect all providers from the costs of 18
services to patients who are ineligible for insurance coverage in circumstances where a payor 19
provides eligibility verification based on best information available to the payor at the date of the 20
request of eligibility. 21
(2) Developing implementation guidelines and promoting adoption of the guidelines for: 22
(i) The use of the National Correct Coding Initiative code-edit policy by payors and 23
providers in the state; 24
(ii) Publishing any variations from codes and mutually exclusive codes by payors in a 25
manner that makes for simple retrieval and implementation by providers; 26
(iii) Use of Health Insurance Portability and Accountability Act standard group codes, 27
reason codes, and remark codes by payors in electronic remittances sent to providers; 28
(iv) Uniformity in the processing of claims by payors; and the processing of corrections to 29
claims by providers and payors; 30
(v) A standard payor-denial review process for providers when they request a 31
reconsideration of a denial of a claim that results from differences in clinical edits where no single, 32
common-standards body or process exists and multiple conflicting sources are in use by payors and 33
providers. 34
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(vi) Nothing in this section, nor in the guidelines developed, shall inhibit an individual 1
payor’s ability to employ, and not disclose to providers, temporary code edits for the purpose of 2
detecting and deterring fraudulent billing activities. The guidelines shall require that each payor 3
disclose to the provider its adjudication decision on a claim that was denied or adjusted based on 4
the application of such edits and that the provider have access to the payor’s review and appeal 5
process to challenge the payor’s adjudication decision. 6
(vii) Nothing in this subsection shall be construed to modify the rights or obligations of 7
payors or providers with respect to procedures relating to the investigation, reporting, appeal, or 8
prosecution under applicable law of potentially fraudulent billing activities. 9
(3) Developing and promoting widespread adoption by payors and providers of guidelines 10
to: 11
(i) Ensure payors do not automatically deny claims for services when extenuating 12
circumstances make it impossible for the provider to obtain a preauthorization before services are 13
performed or notify a payor within an appropriate standardized timeline of a patient’s admission; 14
(ii) Require payors to use common and consistent processes and time frames when 15
responding to provider requests for medical management approvals. Whenever possible, such time 16
frames shall be consistent with those established by leading national organizations and be based 17
upon the acuity of the patient’s need for care or treatment. For the purposes of this section, medical 18
management includes prior authorization of services, preauthorization of services, precertification 19
of services, post-service review, medical-necessity review, and benefits advisory; 20
(iii) Develop, maintain, and promote widespread adoption of a single, common website 21
where providers can obtain payors’ preauthorization, benefits advisory, and preadmission 22
requirements; 23
(iv) Establish guidelines for payors to develop and maintain a website that providers can 24
use to request a preauthorization, including a prospective clinical necessity review; receive an 25
authorization number; and transmit an admission notification; 26
(v) Develop and implement the use of programs that implement selective prior 27
authorization requirements, based on stratification of healthcare providers’ performance and 28
adherence to evidence-based medicine with the input of contracted healthcare providers and/or 29
provider organizations. Such criteria shall be transparent and easily accessible to contracted 30
providers. Such selective prior authorization programs shall be available when healthcare providers 31
participate directly with the insurer in risk-based payment contracts and may be available to 32
providers who do not participate in risk-based contracts; 33
(vi) Require the review of medical services, including behavioral health services, and 34
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prescription drugs, subject to prior authorization on at least an annual basis, with the input of 1
contracted healthcare providers and/or provider organizations. Any changes to the list of medical 2
services, including behavioral health services, and prescription drugs requiring prior authorization, 3
shall be shared via provider-accessible websites; 4
(vii) Improve communication channels between health plans, healthcare providers, and 5
patients by: 6
(A) Requiring transparency and easy accessibility of prior authorization requirements, 7
criteria, rationale, and program changes to contracted healthcare providers and patients/health plan 8
enrollees which may be satisfied by posting to provider-accessible and member-accessible 9
websites; and 10
(B) Supporting: 11
(I) Timely submission by healthcare providers of the complete information necessary to 12
make a prior authorization determination, as early in the process as possible; and 13
(II) Timely notification of prior authorization determinations by health plans to impacted 14
health plan enrollees, and healthcare providers, including, but not limited to, ordering providers, 15
and/or rendering providers, and dispensing pharmacists which may be satisfied by posting to 16
provider-accessible websites or similar electronic portals or services; 17
(viii) Increase and strengthen continuity of patient care by: 18
(A) Defining protections for continuity of care during a transition period for patients 19
undergoing an active course of treatment, when there is a formulary or treatment coverage change 20
or change of health plan that may disrupt their current course of treatment and when the treating 21
physician determines that a transition may place the patient at risk; and for prescription medication 22
by allowing a grace period of coverage to allow consideration of referred health plan options or 23
establishment of medical necessity of the current course of treatment; 24
(B) Requiring continuity of care for medical services, including behavioral health services, 25
and prescription medications for patients on appropriate, chronic, stable therapy through 26
minimizing repetitive prior authorization requirements; and which for prescription medication shall 27
be allowed only on an annual review, with exception for labeled limitation, to establish continued 28
benefit of treatment; and 29
(C) Requiring communication between healthcare providers, health plans, and patients to 30
facilitate continuity of care and minimize disruptions in needed treatment which may be satisfied 31
by posting to provider-accessible websites or similar electronic portals or services; 32
(D) Continuity of care for formulary or drug coverage shall distinguish between FDA 33
designated interchangeable products and proprietary or marketed versions of a medication; 34
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(ix) Encourage healthcare providers and/or provider organizations and health plans to 1
accelerate use of electronic prior authorization technology, including adoption of national standards 2
where applicable; and 3
(x) For the purposes of subsections (h)(3)(v) through (h)(3)(x) of this section, the 4
workgroup meeting may be conducted in part or whole through electronic methods. 5
(4) To provide a report to the house and senate, on or before January 1, 2017, with 6
recommendations for establishing guidelines and regulations for systems that give patients 7
electronic access to their claims information, particularly to information regarding their obligations 8
to pay for received medical services, pursuant to 45 C.F.R. § 164.524. 9
(5) No provision of this subsection (h) shall preclude the ongoing work of the office of 10
health insurance commissioner’s administrative simplification task force, which includes meetings 11
with key stakeholders in order to improve, and provide recommendations regarding, the prior 12
authorization process. 13
(i) To issue an anti-cancer medication report. Not later than June 30, 2014, and annually 14
thereafter, the office of the health insurance commissioner (OHIC) shall provide the senate 15
committee on health and human services, and the house committee on corporations, with: (1) 16
Information on the availability in the commercial market of coverage for anti-cancer medication 17
options; (2) For the state employee’s health benefit plan, the costs of various cancer-treatment 18
options; (3) The changes in drug prices over the prior thirty-six (36) months; and (4) Member 19
utilization and cost-sharing expense. 20
(j) To monitor the adequacy of each health plan’s compliance with the provisions of the 21
federal Mental Health Parity Act, including a review of related claims processing and 22
reimbursement procedures. Findings, recommendations, and assessments shall be made available 23
to the public. 24
(k) To monitor the transition from fee-for-service and toward global and other alternative 25
payment methodologies for the payment for healthcare services. Alternative payment 26
methodologies should be assessed for their likelihood to promote access to affordable health 27
insurance, health outcomes, and performance. To ensure that population-based contracts shall 28
include a provision that agrees on a budget for each contract year, review and prior approval by the 29
office of the health insurance commissioner shall be required if any annual increase in the total cost 30
of care for services reimbursed under the contract, after risk adjustment, exceeds the Consumer 31
Price Index for all Urban Consumers (CPI-U) percentage increase (reported by the commissioner 32
by October 1 of each year, in accordance with established regulations). Such percentage increase 33
shall be plus three and one-half percent (3.5%) beginning October 1, 2025 and ending on September 34
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30, 2028. 1
(l) To report annually, no later than July 1, 2014, then biannually thereafter, on hospital 2
payment variation, including findings and recommendations, subject to available resources. 3
(m) Notwithstanding any provision of the general or public laws or regulation to the 4
contrary, provide a report with findings and recommendations to the president of the senate and the 5
speaker of the house, on or before April 1, 2014, including, but not limited to, the following 6
information: 7
(1) The impact of the current, mandated healthcare benefits as defined in §§ 27-18-48.1, 8
27-18-60, 27-18-62, 27-18-64, similar provisions in chapters 19, 20 and 41 of title 27, and §§ 27-9
18-3(c), 27-38.2-1 et seq., or others as determined by the commissioner, on the cost of health 10
insurance for fully insured employers, subject to available resources; 11
(2) Current provider and insurer mandates that are unnecessary and/or duplicative due to 12
the existing standards of care and/or delivery of services in the healthcare system; 13
(3) A state-by-state comparison of health insurance mandates and the extent to which 14
Rhode Island mandates exceed other states benefits; and 15
(4) Recommendations for amendments to existing mandated benefits based on the findings 16
in (m)(1), (m)(2), and (m)(3) above. 17
(n) On or before July 1, 2014, the office of the health insurance commissioner, in 18
collaboration with the director of health and lieutenant governor’s office, shall submit a report to 19
the general assembly and the governor to inform the design of accountable care organizations 20
(ACOs) in Rhode Island as unique structures for comprehensive healthcare delivery and value-21
based payment arrangements, that shall include, but not be limited to: 22
(1) Utilization review; 23
(2) Contracting; and 24
(3) Licensing and regulation. 25
(o) On or before February 3, 2015, the office of the health insurance commissioner shall 26
submit a report to the general assembly and the governor that describes, analyzes, and proposes 27
recommendations to improve compliance of insurers with the provisions of § 27-18-76 with regard 28
to patients with mental health and substance use disorders. 29
(p) To work to ensure the health insurance coverage of behavioral health care under the 30
same terms and conditions as other health care, and to integrate behavioral health parity 31
requirements into the office of the health insurance commissioner insurance oversight and 32
healthcare transformation efforts. 33
(q) To work with other state agencies to seek delivery system improvements that enhance 34
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access to a continuum of mental health and substance use disorder treatment in the state; and 1
integrate that treatment with primary and other medical care to the fullest extent possible. 2
(r) To direct insurers toward policies and practices that address the behavioral health needs 3
of the public and greater integration of physical and behavioral healthcare delivery. 4
(s) The office of the health insurance commissioner shall conduct an analysis of the impact 5
of the provisions of § 27-38.2-1(i) on health insurance premiums and access in Rhode Island and 6
submit a report of its findings to the general assembly on or before June 1, 2023. 7
(t) To undertake the analyses, reports, and studies contained in this section: 8
(1) The office shall hire the necessary staff and prepare a request for proposal for a qualified 9
and competent firm or firms to undertake the following analyses, reports, and studies: 10
(i) The firm shall undertake a comprehensive review of all social and human service 11
programs having a contract with or licensed by the state or any subdivision of the department of 12
children, youth and families (DCYF), the department of behavioral healthcare, developmental 13
disabilities and hospitals (BHDDH), the department of human services (DHS), the department of 14
health (DOH), and Medicaid for the purposes of: 15
(A) Establishing a baseline of the eligibility factors for receiving services; 16
(B) Establishing a baseline of the service offering through each agency for those 17
determined eligible; 18
(C) Establishing a baseline understanding of reimbursement rates for all social and human 19
service programs including rates currently being paid, the date of the last increase, and a proposed 20
model that the state may use to conduct future studies and analyses; 21
(D) Ensuring accurate and adequate reimbursement to social and human service providers 22
that facilitate the availability of high-quality services to individuals receiving home and 23
community-based long-term services and supports provided by social and human service providers; 24
(E) Ensuring the general assembly is provided accurate financial projections on social and 25
human service program costs, demand for services, and workforce needs to ensure access to entitled 26
beneficiaries and services; 27
(F) Establishing a baseline and determining the relationship between state government and 28
the provider network including functions, responsibilities, and duties; 29
(G) Determining a set of measures and accountability standards to be used by EOHHS and 30
the general assembly to measure the outcomes of the provision of services including budgetary 31
reporting requirements, transparency portals, and other methods; and 32
(H) Reporting the findings of human services analyses and reports to the speaker of the 33
house, senate president, chairs of the house and senate finance committees, chairs of the house and 34
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senate health and human services committees, and the governor. 1
(2) The analyses, reports, and studies required pursuant to this section shall be 2
accomplished and published as follows and shall provide: 3
(i) An assessment and detailed reporting on all social and human service program rates to 4
be completed by January 1, 2023, including rates currently being paid and the date of the last 5
increase; 6
(ii) An assessment and detailed reporting on eligibility standards and processes of all 7
mandatory and discretionary social and human service programs to be completed by January 1, 8
2023; 9
(iii) An assessment and detailed reporting on utilization trends from the period of January 10
1, 2017, through December 31, 2021, for social and human service programs to be completed by 11
January 1, 2023; 12
(iv) An assessment and detailed reporting on the structure of the state government as it 13
relates to the provision of services by social and human service providers including eligibility and 14
functions of the provider network to be completed by January 1, 2023; 15
(v) An assessment and detailed reporting on accountability standards for services for social 16
and human service programs to be completed by January 1, 2023; 17
(vi) An assessment and detailed reporting by April 1, 2023, on all professional licensed 18
and unlicensed personnel requirements for established rates for social and human service programs 19
pursuant to a contract or established fee schedule; 20
(vii) An assessment and reporting on access to social and human service programs, to 21
include any wait lists and length of time on wait lists, in each service category by April 1, 2023; 22
(viii) An assessment and reporting of national and regional Medicaid rates in comparison 23
to Rhode Island social and human service provider rates by April 1, 2023; 24
(ix) An assessment and reporting on usual and customary rates paid by private insurers and 25
private pay for similar social and human service providers, both nationally and regionally, by April 26
1, 2023; and 27
(x) Completion of the development of an assessment and review process that includes the 28
following components: eligibility; scope of services; relationship of social and human service 29
provider and the state; national and regional rate comparisons and accountability standards that 30
result in recommended rate adjustments; and this process shall be completed by September 1, 2023, 31
and conducted biennially hereafter. The biennial rate setting shall be consistent with payment 32
requirements established in § 1902(a)(30)(A) of the Social Security Act, 42 U.S.C. § 33
1396a(a)(30)(A), and all federal and state law, regulations, and quality and safety standards. The 34
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results and findings of this process shall be transparent, and public meetings shall be conducted to 1
allow providers, recipients, and other interested parties an opportunity to ask questions and provide 2
comment beginning in September 2023 and biennially thereafter. 3
(3) In fulfillment of the responsibilities defined in subsection (t), the office of the health 4
insurance commissioner shall consult with the Executive Office of Health and Human Services. 5
(u) Annually, each department (namely, EOHHS, DCYF, DOH, DHS, and BHDDH) shall 6
include the corresponding components of the assessment and review (i.e., eligibility; scope of 7
services; relationship of social and human service provider and the state; and national and regional 8
rate comparisons and accountability standards including any changes or substantive issues between 9
biennial reviews) including the recommended rates from the most recent assessment and review 10
with their annual budget submission to the office of management and budget and provide a detailed 11
explanation and impact statement if any rate variances exist between submitted recommended 12
budget and the corresponding recommended rate from the most recent assessment and review 13
process starting October 1, 2023, and biennially thereafter. 14
(v) The general assembly shall appropriate adequate funding as it deems necessary to 15
undertake the analyses, reports, and studies contained in this section relating to the powers and 16
duties of the office of the health insurance commissioner. 17
(w) To ensure that hospital contracts shall include a provision that agrees on rates for each 18
contract year, review and prior approval by the office of the health insurance commissioner shall 19
be required if the average rate increase including estimated quality incentive payments is greater 20
than the Consumer Price Index for all Urban Consumers (CPI-U) percentage increase (reported by 21
the commissioner by October 1 each year, in accordance with established regulations). Such 22
percentage increase shall be plus three percent (3%) beginning October 1, 2025 and ending on 23
September 30, 2028. 24
SECTION 2. This act shall take effect upon passage. 25
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EXPLANATION
BY THE LEGISLATIVE COUNCIL
OF
A N A C T
RELATING TO STATE AFFAIRS AND GOVERNMENT -- THE RHODE ISLAND HEALTH
CARE REFORM ACT OF 2004 -- HEALTH INSURANCE OVERSIGHT
***
This act would amend the powers and duties of the office of the health insurance 1
commissioner (OHIC) to review and grant prior approval to payment of healthcare services and 2
hospital contracts, if any annual increase in the total cost of care for services reimbursed and 3
hospital contracts after risk adjustment exceeds the Consumer Price Index for all Urban Consumers 4
(CPI-U) percentage increase. 5
This act would take effect upon passage. 6
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