Home Economy Government Health care community supportive of Neronha’s proposals

Health care community supportive of Neronha’s proposals

By

Katie Castellani

-

06/02/2025

R.I.-Statehouse-3-696x463 — HEALTH CARE leaders across the state are supporting Attorney General Peter F. Neronha's proposals to help the state’s ailing health care system/ PBN FILE PHOTO/NICOLE DOTZENROD

PROVIDENCE – Health care leaders across the state are supporting Attorney General Peter F. Neronha’s proposals to help the state’s ailing health care system. “We appreciate the Attorney General’s strong interest in the health care crisis in our state and his recognition that we need financial solutions now,” Howard Dulude, interim president of the Hospital

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PROVIDENCE – Health care leaders across the state are supporting Attorney General Peter F. Neronha's proposals to help the state’s ailing health care system. “We appreciate the Attorney General’s strong interest in the health care crisis in our state and his recognition that we need financial solutions now,” Howard Dulude, interim president of the Hospital Association of Rhode Island said in a statement. One of Neronha’s proposals, which were unveiled on May 28, includes legislation that would raise Medicaid reimbursement rates to 100% of Medicare rates for primary care. Health care leaders have long lamented that the state’s lagging reimbursement rates are straining practices and turning providers away from practicing in the state. This move earned praise from health care groups, including the Rhode Island Medical Society and Care Transformation Collaborative of Rhode Island. Dr. Michael Fine, former director of the R.I. Department of Health, acknowledged reimbursement rate increases are necessary, but said he’s concerned about the affordability of the measure given the state’s current budget gap. Also, the measure only changes one piece of the state’s reimbursement model, which needs an overhaul, he said. Fine praised Neronha’s proposal to reduce prior authorization requirements. A bill introduced May 9., known as the Rhode Island Prior Authorization Reform Act of 2025, would make it illegal for insurers to impose prior authorization requirements on any procedure, test, treatment, study or prescription drug ordered by a primary care provider. Both the state’s medical society and CTC-RI support eliminating prior authorization requirements, which they – and other health care professionals – say create unnecessary administrative burdens for primary care providers. "Rhode Island faces serious challenges in ensuring access to high-quality, equitable health care. Now more than ever, there is a clear and urgent need to strengthen and sustain primary care – the foundation of our health system,” said John Minichiello, executive director of CTC-RI. “CTC-RI supports efforts that reduce administrative burdens, improve reimbursement, and promote innovation in primary care delivery.” Neronha also announced his office sued the country’s largest pharmacy benefit managers, or PBMs – CVS Caremark, Express Scripts and Optum – and their affiliated group purchasing organizations. The complaint filed in Providence County Superior Court May 27 alleges the PBMs and the group purchasing organizations deceptively brand themselves as helping customers save money, when they profit directly from cost increases. Stacy Paterno, executive vice president of the medical society, supported this move as it helps “Hold PBMs accountable for practices that drive up drug costs and obstruct care.” Meanwhile, CVS spokesperson Amy Thibeault said it was “surprising and unfortunate” Neronha would make “incorrect assertions about our industry to needlessly attack a hometown company.” CVS Caremark saved customers more than $40 billion on their prescription drug costs and members pay less than $8 on average for a 30-day supply of medication, Thibeault said. “The AG’s rhetoric about protecting independent pharmacies is inaccurate and misleading,” Thibeault said, adding there are more independent pharmacies in the state than there were six years ago. “We look forward to productive discussions with all stakeholders to help improve the understanding of our value and not be derailed by misinformation. Our collection of businesses uniquely works together to deliver simply better health. Additional regulation to limit how PBMs operate will likely increase prescription drug costs for Rhode Islanders and serve as a handout to Big Pharma.” Along with the lawsuit against pharmacy benefit managers, and proposals to reduce prior authorization requirements and increase Medicaid reimbursement rates, the medical society is supportive of Neronha’s actions to “expand data capacity to inform state health policy,” Paterno said. “These steps reflect the urgency of the moment and the need to protect access to care, support the healthcare workforce, and ensure a sustainable system for Rhode Island’s patients,” Paterno said. Other proposals include creating a new state agency focused on collecting and analyzing health care data. Neronha expects to share a full proposal for the agency later this year. There is also a new partnership between Neronha’s office and Brown University School of Public Health’s Center for Advancing Health Policy Through Research, or CAHPR. This collaboration would look into potential policy options for state-based health system reform. Neronha’s office has also issued a public notice of a proposed rule to require Rhode Island medical-practice groups to notify his office of any merger, consolidation or acquisition that would result in ownership or control by a private equity investor, a group of eight or more physicians and physician assistants or nurse practitioners. It would also require notification for the creation of a management services organization or similar entity responsible for administering a medical group’s contracts with health insurance carriers or third-party administrators. Fine praised this idea as a way to reduce the “noxious impact” private equity firms have had on health care. Neronha has also issued an advanced notice of proposed rulemaking to assess whether more regulation on the use of Artificial Intelligence is needed. Most of what Neronha introduced aligns with the Senate’s 2025 health care package, said Senate President Valerie Lawson. More specifically, reforming pharmacy benefit managers’ pricing, reducing prior authorization requirements and raising Medicaid reimbursement rates. Lawson said the Senate Finance Committee has been exploring options to expedite the rate review for primary care reimbursement and offer an interim infusion of financial support for practices while the review is underway. However, she said there needs to be more support for primary care training in the state. Speaker of the House K. Joseph Shekarchi says he appreciates Neronha’s health care proposals, but is waiting to form an opinion until he’s reviewed them. “I will reserve judgment until reviewing the proposals and learning more about their fiscal impact in a very challenging budget year,” Shekarchi said in a statement. Neronha's proposals come after Gov. Daniel J. McKee unveiled plans in April to boost the state’s primary care system in the wake of the announcement on Anchor Medical’s closure. McKee’s strategy included six parts: accelerating a primary care Medicaid rate review; requiring commercial health insurers to increase funding for primary care reimbursements; reducing red tape by easing prior authorization requirements; providing grants to help primary care practices serve additional patients and hire new providers; strengthening fiscal oversight of the state’s health care system; and expanding the primary care student loan forgiveness program. The R.I. Department of Health backed McKee’s proposals while Neronha blasted them as “talking points and half-baked.” Spokespeople for McKee’s office and the R.I. Department of Health did not respond to PBN’s request for comment. Katie Castellani is a PBN staff writer. You may contact her at Castellani@PBN.com.