2025 -- H 5851

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LC001653

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2025

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A N   A C T

RELATING TO INSURANCE -- CONTRACT WITH HEALTHCARE PROVIDERS

     

     Introduced By: Representatives Morales, Stewart, Felix, Tanzi, Handy, Cruz, Potter, and
Caldwell

     Date Introduced: February 28, 2025

     Referred To: House Health & Human Services

     It is enacted by the General Assembly as follows:

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     SECTION 1. Section 27-20.9-3 of the General Laws in Chapter 27-20.9 entitled "Contract

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with Healthcare Providers" is hereby amended to read as follows:

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     27-20.9-3. Pay-for-performance guidelines.

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     A health insurer shall not require a physician, as a condition of contracting, to participate

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in any financial or reimbursement incentive program, commonly referred to as pay-for-

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performance programs, unless such program meets the principles and guidelines for pay-for-

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performance programs endorsed by the national quality forum and adopted by the AQA Alliance

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or the hospital quality alliance, or similar principles and guidelines for pay-for-performance

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programs approved by the office of the health insurance commissioner "capitation," or any other

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"alternative payment model" that creates a financial incentive for a physician to limit medically

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necessary care or to choose to keep low need patients or not to keep high need patients.

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     SECTION 2. This act shall take effect upon passage.

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LC001653

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE -- CONTRACT WITH HEALTHCARE PROVIDERS

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     This act would amend the current law in order that a health insurer would not require a

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physician, as a condition of contracting, to participate in any financial or reimbursement incentive

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program, commonly referred to as "capitation," or any other "alternative payment model" that

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creates a financial incentive for a physician to limit medically necessary care or to choose to keep

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low need patients or not to keep high need patients.

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     This act would take effect upon passage.

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