RELATING TO BUSINESSES AND PROFESSIONS -- THE PRIMARY CARE, PRESERVATION ACT
Summary
H7427 creates the “Primary Care Preservation Act” by adding a new chapter to Title 5 governing businesses and professions. The bill defines an “administrative or operational fee” as a reasonable charge a physician practice may assess patients for non-clinical services that support office operations, such as scheduling, care coordination, communication systems, record handling, and similar overhead functions. It also defines “payor” broadly to include insurers, health maintenance organizations, and other entities responsible for payment of healthcare services, and “physician practice” as an outpatient medical practice owned or operated by licensed physicians in Rhode Island.
The core of the bill prohibits payors from including contract terms that bar, restrict, penalize, or interfere with a physician practice’s ability to charge, bill, or collect these fees directly from patients. Payors also may not impose conditions, penalties, or sanctions on a practice for assessing such fees, so long as the fees are disclosed in advance to patients and are not billed to the payor. The bill does not require insurers to reimburse the fees, and it preserves a practice’s obligation to provide emergency or urgent care and to provide reasonable access to medical records consistent with state and federal law. Any conflicting contract provision would be void and unenforceable, and the act would take effect immediately upon passage.
Impact
If enacted, the bill would limit the ability of health insurers and other payors to control physician practice billing arrangements through participation agreements, specifically by preventing contract language that blocks patient-facing administrative or operational fees. It would create a new statutory rule in Rhode Island law governing physician-payor contracts and would make contrary provisions unenforceable as a matter of public policy. The practical effect would be to give physician practices more flexibility to shift some overhead costs to patients, while leaving insurers free not to reimburse those fees.
Sentiment
The available context suggests the bill is framed as a support measure for primary care and physician practices, with sponsors presenting it as a way to preserve practice viability and cover overhead costs. Because there are no committee transcripts or recorded votes provided, there is no documented opposition or floor debate in the supplied materials. Based on the bill text and caption, the general sentiment appears favorable toward physician practices and neutral to cautious from the payer perspective, since the measure directly limits insurer contract terms.
Contention
The main point of contention is likely the policy choice to allow physician practices to charge patients separate administrative or operational fees. Supporters would view this as a way to help practices cover rising overhead and maintain access to care, while insurers and other payors may object that the bill weakens their contracting leverage and could increase out-of-pocket costs for patients. Another possible concern is patient transparency and affordability, although the bill requires advance disclosure and does not permit billing the payor. The bill also preserves emergency and urgent care obligations, which may address concerns that fee collection could affect access to necessary treatment.
Includes the definition of "primary care services" and requires that all biennial reports shall include a review and recommendation of rates for primary care services on and after September 1, 2025.
Includes the definition of "primary care services" and requires that all biennial reports shall include a review and recommendation of rates for primary care services on and after September 1, 2025.
Authorizes a physician practice to charge a practice support contribution; provided that, the amount does not exceed $120 per year, per patient, enrolled in a healthcare insurance plan, (excluding Medicaid and traditional Medicare).
Adds to the powers and duties of the OHIC the undertaking of analyses, reports, studies, and recommendations with respect to reimbursement and financing for the provision of primary care services to Rhode Islanders.
Requires the executive office of health and human services to increase Medicaid payment rates for primary care services furnished by primary care providers to be commensurate with Medicare rates.
Prohibits an insurer from imposing a requirement of prior authorization for any admission, item, service, treatment, test, exam, study, procedure, or any generic or brand name prescription drug ordered by a primary care provider.