Legislation would free PCPs from time-consuming roadblock to patient care
STATE HOUSE – Rep. Brandon Potter and Sen. Linda L. Ujifusa have introduced legislation to eliminate a barrier to health care by prohibiting health insurers from requiring prior authorization for treatment and services ordered by a patient’s primary care provider.
The legislation (2025-H 5120, 2025-S 0053), which was introduced in the House and the Senate this week, is meant to help patients access the care they need in a timely manner while also decreasing the administrative burden on primary care providers (PCPs) so they can focus on patient care.
“Prior authorization is a tool used by insurance corporations to block patients from getting what their doctors ordered. It’s based on the false assumption that doctors and patients ‘over-utilize’ goods and services and need to be ‘managed’ by private insurers,” said Senator Ujifusa (D-Dist. 11, Portsmouth, Bristol). “In fact, requiring PCP prior authorizations delays or prevents patients from getting tests and treatments —making diseases harder to treat or requiring trips to the emergency room. This bill allows PCPs to spend more time caring for patients, not fighting for permission from corporations who profit from limiting care.”
Freeing PCPs from the tremendous administrative burdens posed by prior authorization requirements is particularly important as Rhode Island struggles with a shortage of PCPs.
“We know all too well that Rhode Islanders are struggling to find primary care doctors, and those fortunate enough to have one are facing longer waits for appointments. The situation is only made worse when doctors have to spend their time battling insurance companies instead of treating patients. This is a step to ease that burden, expand access to basic health care, and ensure medical decisions are made by doctors based on what’s best for patients — not by insurance companies prioritizing their bottom line,” said Representative Potter (D-Dist. 16, Cranston).
The legislation would prohibit insurers from imposing prior authorization requirements for any admission, item, service, treatment, or procedure ordered by an in-network primary care provider, including general internists, family physicians, pediatricians, geriatricians, OB-GYNs, nurse practitioners, physician assistants and other health care providers who are licensed to provide, coordinate, and supervise primary care and order health care services and goods, including preventive and diagnostic services for patients.
If approved, the bill would take effect July 1, 2026.
According to the American Medical Association, which has been advocating to reduce prior authorization requirements, the average physician practice completes 45 prior authorizations per physician per week. According to the most recent AMA survey, 94% of physicians believe prior authorization delays care.
The Rhode Island Medical Society has also advocated for reductions in prior authorization requirements.
“This legislation is a step in the right direction to address the significant challenges physicians face due to prior authorization requirements. These burdens delay care, increase administrative strain, and ultimately impact patient outcomes. We appreciate the leadership of Representative Potter and Senator Ujifusa in tackling this issue and remain committed to advocating for further reforms that support timely, patient-centered care” said Rhode Island Medical Society President Dr. Kara Stavros.
For more information, contact:
Meredyth R. Whitty, Publicist
State House Room 20
Providence, RI 02903
(401) 222-1923
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