Rhode Island Legislative Updates

Insulin copay cap

• Caps the copay on prescription insulin drugs at $40.00 per (30) day supply
• Prescription insulin drugs not subject to any deductible
• Effective 1/1/22

Reimbursement for perinatal doulas

• Requires insurers to reimburse certified doulas for services already covered when performed by other licensed provider types
• Effective 1/1/22

Coverage of telemedicine

• Payment parity for BH, primary care, and nutritionist providers
• Cost share not to exceed the same in-person service
• Prior authorization no more stringent than in-person
• Effective 1/1/22

Gender rating

• Prohibits use of gender as a rating factor
• ACA already prohibits gender rating in the small and individual markets
• Effective 1/1/23

Federal Regulatory Mandates

 

The Consolidated Appropriations Act

A consolidated federal COVID-19 relief bill, with healthcare provisions related to surprise medical billing, mandates to increase overall transparency throughout insurance plan transactions, and extending funding and protections for public health care and Medicaid and Medicare programs.

Notable provisions include, but are not limited to, the following:

• Effective 1/1/22- Ensuring members will be held harmless from balance bills for emergency services, certain out-of-network services obtained at in-network facilities and air ambulance transportation
• Effective 1/1/22- Updates to member ID cards to display any applicable deductibles and out-of-pocket maximums
• Preparations for generation of an Advance Explanation of Benefits upon notification from a provider or facility that a member is scheduled to receive an item/service
• Effective 1/1/22- Provisions for continuity of care
• Effective 1/1/23- Internet-based self-service treatment cost estimate tool
• Effective 1/1/22- Plans are required to have up-to-date directories of their in-network providers.

Transparency in coverage

Most health insurance issuers offering non-grandfathered coverage in the individual and group markets will be required to make available to the public, including stakeholders (e.g., consumers, researchers, employers, and third-party developers):

• Three separate, machine-readable files be posted publicly that detail in-network, negotiated rates for covered services; billed charges and historical payments from/to out of network providers; and in-network negotiated rates and historical pricing for all covered prescription drugs at the pharmacy location level.
• Personalized out-of-pocket cost information, and the underlying negotiated rates, for all covered health care items and services, including prescription drugs, through an internet-based self-service tool and in paper form upon request. Effective dates are further out to 2023 and 2024.