RELATING TO INSURANCE -- FEE SCHEDULE TRANSPARENCY AND FAIR BILLING, ACT
Summary
H8309 creates a new chapter in Rhode Island insurance law called the “Fee Schedule Transparency and Fair Billing Act.” It would require every insurer to provide participating physicians, physician practices, physician corporations, physician partnerships, and other medical service entities with a complete and current fee schedule showing the maximum allowable reimbursement for every covered service and procedure code. Insurers would have to update those schedules within 30 days of any change and make them available through secure provider portals.
The bill also requires insurers to pay claims in full when they are submitted at or below the published maximum allowable rate. It prohibits insurers from reducing payment, applying bundling restrictions, or imposing penalties solely because of the amount charged when that charge does not exceed the published maximum. The Office of the Health Insurance Commissioner would be responsible for enforcing the chapter, including the authority to impose penalties of up to $25,000 per violation and to publish annual reports on fee schedule availability and billing disputes.
Impact
If enacted, the bill would add a new regulatory framework to Title 27 governing insurer reimbursement practices and provider access to pricing information. It would affect health insurers, nonprofit medical service corporations, hospital service corporations, HMOs, and other entities defined as insurers under Rhode Island law, while also benefiting physicians and other medical providers by giving them clearer advance notice of reimbursement limits. The measure would likely reduce disputes over payment amounts and could constrain insurer discretion in processing claims that fall within published fee schedules.
Sentiment
Based on the bill text and the absence of recorded committee testimony or votes, the overall sentiment appears to be supportive of provider transparency and fair billing practices. The bill is framed as a consumer- and provider-protection measure aimed at making reimbursement rules more predictable and reducing billing disputes. Because there is no available discussion or voting history, there is no documented opposition or support from specific legislators or stakeholders in the provided materials.
Contention
The main point of contention is likely to be the bill’s effect on insurer payment flexibility and administrative burden. Insurers may object to mandatory publication of complete fee schedules, the 30-day update requirement, and the prohibition on reductions or penalties tied to charge amounts, arguing that these provisions limit their ability to manage costs and claims. Physicians and provider groups, by contrast, are the likely supporters because the bill would improve reimbursement transparency and protect payment for claims billed within the published maximum allowable rate.
Provides certain controls over prescription drug costs by imposing transparency, oversight and accountability requirements on commercial insurers and their pharmacy benefit managers.
Provides certain controls over prescription drug costs by imposing transparency, oversight and accountability requirements on commercial insurers and their pharmacy benefit managers.
Amends powers/duties of the office of the health insurance commissioner to increase total cost of care for services reimbursed under contracts after risk adjustment that exceeds the Consumer Price Index for all Urban Consumers percentage increase.
Amends powers/duties of the office of the health insurance commissioner to increase total cost of care for services reimbursed under contracts after risk adjustment that exceeds the Consumer Price Index for all Urban Consumers percentage increase.
Establishes a single-payer health care insurance system, consolidating public and private payments into a more efficient Medicare-for-all style program, funded by progressive taxes, to reduce health care costs.
Establishes a single-payer health care insurance system, consolidating public and private payments into a more efficient Medicare-for-all style program, funded by progressive taxes, to reduce health care costs.