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.

Plain-English Summary

This bill would place new limits on when health insurance companies in Rhode Island can require "prior authorization" for certain medical treatments. Prior authorization is a process where a patient's doctor must get approval from the insurance company before providing care — a step that can delay treatment. Specifically, this bill focuses on rehabilitative services (like physical therapy after an injury) and habilitative services (therapies that help people develop or maintain daily living skills, often used by people with disabilities).

Under this bill, insurance companies would be prohibited from requiring prior authorization for the first 12 visits when a patient begins a new episode of care — meaning if you start a new course of treatment, you could see your therapist or specialist up to 12 times without waiting for insurance approval. Additionally, if a patient is newly diagnosed with chronic pain, the insurance company could not require prior authorization for any related treatment during the first 90 days following that diagnosis.

This bill would affect Rhode Island residents who have accident and sickness insurance policies — essentially anyone with private health insurance in the state. It would also affect healthcare providers, who currently spend time navigating prior authorization paperwork, and insurance companies, who would face new restrictions on when they can require it.

As of now, the bill has been introduced and referred to the House Health & Human Services Committee, which has recommended holding it for further study, meaning it has not yet moved forward in the legislative process.