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6/20/2025
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General Assembly approves bill to reduce prior authorization requirements for primary care
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 Legislation creates a 3-year pilot program freeing PCPs from time-consuming roadblock to patient care
STATE HOUSE – The General Assembly today approved legislation sponsored by Senate Health and Human Services Committee Chairwoman Melissa Murray and Rep. Brandon Potter to create a three-year pilot program prohibiting insurers from requiring prior authorization for medically necessary health care services ordered by patients’ primary care providers.
The legislation (2025-S 0168B, 2025-H 5120A), which now goes to the governor, is meant to remove a roadblock that slows down patient care and consumes hours of primary care providers’ and their staffs’ time each day.
The bill is included the package of legislation endorsed by Senate leadership this session to address health care accessibility and affordability.
“It is the health care providers, not insurers, who know best what care is needed for their patients. And we need our primary care providers focused on providing care, not haggling with insurance companies,” said Chairwoman Murray (D-Dist. 24, Woonsocket, North Smithfield).
Said Representative Potter (D-Dist. 16, Cranston), “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.”
The legislation would, for the three years beginning Oct. 1, prohibit insurers from imposing prior authorization requirements for any admission, item, service, treatment, or procedure ordered by a primary care provider, including general internists, family physicians, pediatricians, geriatricians, OB-GYNs, nurse practitioners, physician assistants and other health care providers who are credentialed with the insurer as a primary care provider. The prohibition does not extend to prescription drugs.
The bill requires annual reports from all insurers in Rhode Island, as well as from a workgroup from the Office of the Health Insurance Commissioner, to assist in assessing the success of the pilot program at improving access to primary care services, availability of staff to perform other office functions, increases in patient appointments and reductions in care delay.
If the pilot is found effective, it would be up to the General Assembly to vote to extend the program past its Oct. 1, 2028, expiration.
“Rhode Island’s primary care system is at a breaking point. The recent closure of Anchor Medical left more than 25,000 patients searching for new primary care physicians — adding immense strain to a system already struggling to meet demand. Practices are reporting long wait times, limited capacity and increasing burnout. In this context, we must take immediate focused steps to strengthen the foundation of our health care system: primary care,” said Dr. Kara Stavros, president of the Rhode Island Medical Society, in written testimony in favor of the legislation. “One of the most burdensome and unnecessary barriers to timely care is prior authorization. While intended as a cost-control measure, in practice, it delays needed treatment, increases administrative waste and undermines clinical decision-making. … In this moment of crisis, we cannot allow bureaucratic process to interfere with patients’ ability to access timely, effective care. Rhode Islanders deserve better.”
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.
For more information, contact:
Meredyth R. Whitty, Publicist
State House Room 20
Providence, RI 02903
(401) 222-1923
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