2024 -- H 8074

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LC005655

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2024

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A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

     

     Introduced By: Representatives Cardillo, Lima, Azzinaro, Noret, Phillips, Serpa, Vella-
Wilkinson, O'Brien, Chippendale, and Craven

     Date Introduced: March 15, 2024

     Referred To: House Health & Human Services

     It is enacted by the General Assembly as follows:

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     SECTION 1. Chapter 27-18 of the General Laws entitled "Accident and Sickness Insurance

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Policies" is hereby amended by adding thereto the following section:

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     27-18-95. Primary care referrals.

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     (a) On or after January 1, 2025, every individual or group health insurance contract, plan,

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or policy that is delivered, issued for delivery, prescribed, or renewed in this state shall not require

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a patient to obtain a referral for a specialist from their primary care provider (PCP) in order to

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address their health care needs.

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     (b) The insurer shall not require a higher or additional copay or coinsurance coverage after

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the application of the deductible for visiting a specialist without a primary care referral.

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     SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service

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Corporations" is hereby amended by adding thereto the following section:

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     27-19-87. Primary care referrals.

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     (a) On or after January 1, 2025, every individual or group health insurance contract, plan,

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or policy that is delivered, issued for delivery, prescribed, or renewed in this state shall not require

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a patient to obtain a referral for a specialist from their primary care provider (PCP) in order to

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address their health care needs.

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     (b) The insurer shall not require a higher or additional copay or coinsurance coverage after

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the application of the deductible for visiting a specialist without a primary care referral.

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     SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service

 

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Corporations" is hereby amended by adding thereto the following section:

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     27-20-83. Primary care referrals.

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     (a) On or after January 1, 2025, every individual or group health insurance contract, plan,

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or policy that is delivered, issued for delivery, prescribed, or renewed in this state shall not require

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a patient to obtain a referral for a specialist from their primary care provider (PCP) in order to

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address their health care needs.

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     (b) The insurer shall not require a higher or additional copay or coinsurance coverage after

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the application of the deductible for visiting a specialist without a primary care referral.

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     SECTION 4. Chapter 27-41 of the General Laws entitled "Health Maintenance

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Organizations" is hereby amended by adding thereto the following section:

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     27-41-100. Primary care referrals.

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     (a) On or after January 1, 2025, every individual or group health insurance contract, plan,

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or policy that is delivered, issued for delivery, prescribed, or renewed in this state shall not require

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a patient to obtain a referral for a specialist from their primary care provider (PCP) in order to

15

address their health care needs.

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     (b) The insurer shall not require a higher or additional copay or coinsurance coverage after

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the application of the deductible for visiting a specialist without a primary care referral.

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     SECTION 5. This act shall take effect upon passage.

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LC005655

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

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     This act would remove the requirement for a patient to obtain a referral from their primary

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care provider in order to see a specialist, on or after January 1, 2025.

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     This act would take effect upon passage.

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LC005655

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LC005655 - Page 3 of 3