Attorney General Neronha urges OHIC to “be bold” in efforts to strengthen primary care

Published on Monday, November 18, 2024

Attorney General Peter F. Neronha submitted public comments to the Rhode Island Office of the Health Insurance Commissioner (OHIC) in response to proposed amendments to its regulations governing primary care.  The Attorney General urges OHIC to consider bolder proposals to mitigate the negative effects of two serious issues that challenge the delivery of primary care in Rhode Island: the burden of prior authorization and the lack of retention of primary care physicians.

Last month, OHIC issued proposed amendments to 230-RICR-20-30-4: Powers and Duties of the Office of the Health Commissioner. In its proposal, OHIC proposes regulations that would require insurance companies to reduce prior authorizations by 20% and require companies to allocate 10% of their payments to primary care in the coming years. On prior authorization, the Attorney General encourages OHIC to not only be more aggressive in its proposal, but also to request changes that are data driven, sufficiently researched, and available to the public. With respect to required investments in primary care, the Attorney General encourages OHIC to ensure laser-focused tracking and reporting of how insurance companies are investing, in order to retain the physicians Rhode Island so desperately needs to keep. 

“Year after year, Rhode Islanders are required to pay more and more for their health insurance, and year after year, they see no return on these undue investments,” said Attorney General Neronha. “Consumers expect that the amount they pay for a product will directly reflect the product’s quality, and health insurance stands in stark contrast to this reasonable assumption. While this proposed amendment by OHIC seeks to pull in the reins on these insurance companies, who continue to line their pockets with the hard-earned money of Rhode Islanders, it doesn’t go far enough. If we are to ever fix our health care system, we must be bold and data driven in our approach to cost, administrative red tape, and holding on to our life-saving doctors. Only then can we begin to fix what is clearly broken.”

Specifically, the Attorney General encourages OHIC to:

  1. provide a detailed explanation of its choice to require a 20% reduction in prior authorizations, rather than a larger reduction, and include mechanisms for effective enforcement,
  2. ensure any reduction in prior authorization levels is new and additional reductions, more than any reductions or actions already required by law,
  3. enforce existing law and regulation surrounding prior authorization, and,
  4. require that any increased investment in primary care results in increased payments and support to primary care providers. 

The following excerpts highlight the Attorney General’s comments, found here. 

Prior Authorization

  • “The Attorney General encourages OHIC to release a fully fleshed out explanation as to why only a 20% reduction in prior authorization is a warranted starting point… The burden needs to shift to the insurance companies to produce documents that show why any prior authorization should be required at all…[and] the data required by this proposed regulation should be available to the public for their review and input. And the starting point for those conversations should be a number chosen by OHIC through data collection and vigorous investigation, not a number most convenient to insurance companies.”

Primary Care Funding

  • “The Attorney General agrees that insurance companies need to be held accountable in the Rhode Island marketplace…This proposed update, and the underlying original regulation, focuses on an investment in the primary care system, which includes a wide array of costs, including the overhead of running a practice, including electronic medical systems and basic physical infrastructure. The proposed update changes how OHIC tracks primary care spending and investment and requires insurers to direct 10% of their payments to primary care.  However, there is no mechanism in the proposal to track whether these increased investments are likely to retain individual primary care providers.”
  • “OHIC should update this proposal to include a requirement that all payors subject to the update track and report what percentage of the increased investment in the practice is paid directly to the provider, and what percentage is directly tied to lowering administrative burdens on providers… the backbone of the health care system.”

Read the full comment letter here.

 

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