Skip to main content
H 8327Health Insurance

Insurance - Primary Care Administrative Fairness Act

Requires health insurers to either pay primary care doctors for administrative referral work or remove prior authorization requirements.

Held for study
Population
Affected
65
Email Legislator
Introduced Mar 20, 2026Committee House Health & Human Services

Plain-English Summary

This legislation prohibits health insurers and similar payers from requiring primary care providers to perform administrative referral coordination tasks without payment. Payers must either eliminate prior authorization requirements for referrals initiated by primary care doctors or pay the practice for the administrative costs associated with that coordination. Additionally, the bill mandates that if a lab service is covered under any recognized diagnostic code, it cannot be denied based solely on the specific code used. It also prevents payers from forcing doctors to resubmit claims to match internal coding preferences.

For younger readers

When you visit a doctor, they sometimes need to send you to a specialist. Currently, doctors spend a lot of time filling out paperwork and asking insurance companies for permission to do this. This bill says that insurance companies cannot make doctors do this extra work for free. The insurance companies must either stop asking for this permission work or they must pay the doctors for the time it takes to do it. It also helps make sure medical tests get paid for without extra confusing rules.

Who & Where It Applies

Impacted groups
Primary Care ProvidersHealth Insurers and PayersMedical LaboratoriesPatientsOffice of the Health Insurance Commissioner
Impacted communities
All

Constitutional & Fiscal Check

None Likely

Estimated cost
Amount unknown
Estimated revenue
None

Bill Analysis

Both viewpoints
For Progressives
  • Ensures fair compensation for labor by preventing large insurance corporations from forcing primary care providers to perform uncompensated administrative work.
  • Potentially removes barriers to healthcare access by incentivizing insurers to eliminate prior authorization requirements, which often delay necessary treatment.
  • Supports community health infrastructure by reducing the administrative financial burden on primary care practices, helping them remain viable and available to patients.
  • Insurance companies may pass the increased administrative reimbursement costs on to consumers in the form of higher premiums, disproportionately affecting low-income individuals.
  • The bill does not strictly ban prior authorizations, meaning insurers could choose to pay the fee and keep the bureaucratic hurdles that delay patient care.
  • Does not explicitly address or cap the potential rise in out-of-pocket costs for patients if insurers adjust plan structures to offset these new provider payments.
For Conservatives
  • Protects small business owners (private medical practices) from being forced to provide free labor to large corporate entities.
  • Reduces bureaucratic red tape by encouraging the elimination of prior authorization requirements, streamlining business operations for doctors.
  • Enforces the concept that services rendered (administrative coordination) deserve compensation, upholding fair market principles for providers.
  • Represents government interference in the free market by dictating the specific terms of contracts between private insurance companies and private medical providers.
  • Likely to increase the cost of doing business for insurers, which will almost certainly result in higher insurance premiums for families and businesses.
  • Expands the regulatory authority of the Office of the Health Insurance Commissioner to void private contract provisions, eroding the freedom of contract.

Votes

Loading votes...

Full Bill Text

Changes to existing Rhode Island law · 40 additions

SECTION 1. Title 27 of the General Laws entitled "INSURANCE" is hereby amended by adding thereto the following chapter: 27-84-1. Short title. This chapter shall be known and may be cited as the "Primary Care Administrative Fairness Act." 27-84-2. Definitions. As used in this chapter, the following terms have the following meanings:

(1) "Covered services" means health care services for which a payer provides reimbursement under a participating provider agreement.

(2) “ICD-10” means International Classification of Diseases, 10th revision.

(3) "Payer" means any health insurer, health maintenance organization, managed care organization, or Medicare Advantage plan doing business in this state. 27-84-3. Prohibition on uncompensated referral coordination. No payer shall require a primary care provider to perform uncompensated referral coordination services, including preparation of documentation, submission of prior authorizations, communication with specialists or insurers, tracking of approvals, or transmission of materials. 27-84-4. Payer obligations for referral coordination. A payer shall either:

(1) Eliminate prior authorization requirements for all primary care initiated referrals; or

(2) Reimburse the primary care practice at reasonable attributable costs for each referral coordination service, paid separately and unbundled from evaluation and management payments or capitated payments, including Medicare Advantage payments. 27-84-5. Coverage based on any recognized ICD-10 code. If a laboratory service is covered under any ICD-10 code recognized by the payer, coverage shall not be denied solely because of the specific diagnostic code submitted by the ordering physician. 27-84-6. Prohibition on resubmissions. A payer shall not require a physician or practice to resubmit a claim, modify a code, or provide additional justification solely to satisfy the payer’s internal coding preferences when the service is otherwise covered. 27-84-7. Contract provisions void. Any contract provision that violates this chapter shall be void and unenforceable. 27-84-8. Enforcement. The office of the health insurance commissioner shall enforce the provisions of this chapter and shall:

(1) Require payers to update participating provider agreements no later than January 1, 2027;

(2) Review payer policies for compliance with this chapter;

(3) Void any payer contract provisions that are inconsistent with the requirements of this chapter; and

(4) On and after January 1, 2028 publish an annual report on referral volumes, reimbursements for referral coordination services, and laboratory claim denial rates.

SECTION 2. This act shall take effect on January 1, 2027