H5 120 – Rhode Island

Status: In Process
Year Introduced: 2025
Link: https://status.rilegislature.gov/

This bill provides that an insurer would be prohibited from requiring prior authorization for any admission, item, service, treatment, or procedure ordered by an in-network primary care provider (PCP), with an exception that prior authorization can still be required for prescription drugs. The bill defines key terms such as “primary care provider,” which includes general physicians, family doctors, pediatricians, nurse practitioners, and other healthcare providers who can order medical services. By preventing insurers from imposing prior authorization requirements on services ordered by PCPs, the legislation aims to reduce administrative burdens that may delay medically necessary care. The bill amends several sections of Rhode Island state law to implement this requirement, including giving the Executive Office of Health and Human Services and the Health Insurance Commissioner responsibilities for ensuring insurers comply with the new restriction. The provisions would take effect on July 1, 2026, giving insurers and healthcare systems time to adjust their processes. If any part of the bill is found to be unconstitutional or invalid, that specific provision would be severed while leaving the rest of the bill intact.


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