Home Editor's Choice Neronha unveils initiatives to heal state’s ailing health care system

Neronha unveils initiatives to heal state’s ailing health care system

By

Katie Castellani

-

05/28/2025

Nerhona — ATTORNEY GENERAL Peter F. Neronha on May 28 unveiled initiatives to help heal the state’s ailing health care system. Proposals include a new state agency, a lawsuit against CVS Health Corp. and raising Medicaid reimbursement rates to 100% of Medicare rates for primary care providers. /COURTESY OF ATTORNEY GENERAL PETER F. NERONHA'S OFFICE.

PROVIDENCE – A new state agency, a lawsuit against CVS Health Corp. and a proposed law to raise Medicaid reimbursement rates to 100% of Medicare rates for primary care providers are just a few of the initiatives Attorney General Peter F. Neronha prescribed Wednesday to heal the state’s ailing health care system. “Rhode Island’s health

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1 COMMENT

Howard Schulman 05/28/2025 At 3:39 pm

Sincerely appreciate the Attorney General‘s efforts. We also need to work on reimbursement from the commercial insurance companies like United and Blue Cross for primary care.

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PROVIDENCE – A new state agency, a lawsuit against CVS Health Corp. and a proposed law to raise Medicaid reimbursement rates to 100% of Medicare rates for primary care providers are just a few of the initiatives Attorney General Peter F. Neronha prescribed Wednesday to heal the state’s ailing health care system. “Rhode Island’s health care system, and primary care in particular, is in a state of crisis and facing spectacular failure if we do not act, and act now,” said Neronha. “With these health care-related actions, my office is continuing to pull the levers available to us to contribute to the solution.” One of the eight actions Neronha announced was a lawsuit against 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 Tuesday alleges the PBMs and the group purchasing organizations deceptively brand themselves as helping customers save money, when they profit directly from cost increases. Neronha has proposed creating a new state agency focused on collecting and analyzing health care data to help inform decision making and provide independent oversight. Neronha expects to share a full proposal for the agency later this year. Neronha also announced a collaboration between his office and the Brown University School of Public Health’s Center for Advancing Health Policy Through Research, or CAHPR. The collaboration would look into potential policy options for state-based health system reform. A report from the center shows four options to make health care more accessible and affordable including, a state-based single-payed plan, a comprehensive public option, changes to reach pricing parity across payer segments through raising Medicaid reimbursements with the option of controlling commercial prices and a state prescription drug purchasing pool. Neronha also introduced legislation that would immediately raise Medicaid payments to primary care providers to be 100% on par with Medicare rates. Medicaid reimbursement rates have lagged for primary care services for years leaving practices struggling to cover the cost of care. Currently, Medicaid reimburses 37% The legislation is sponsored by Sen. Pamela Lauria, D-Barrington, and Rep. Megan Cotter, D-Exeter. Another 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. There are exceptions for controlled substances and individual cases of fraud, waste or abuse. Also, any insurer issuing allowed prior authorization must use a single, standardized form. The legislation is sponsored by Rep. Mia Ackerman, D-Cumberland, and the Senate recently passed similar legislation introduced by Sen. Melissa Murray, D-Woonsocket. A bill sponsored by Rep. Susan Donovan, D-Bristol, would amend the state’s Health Care Advocate statute to include new authority for the Health Care Advocate to petition the state Superior Court to place a hospital into receivership. This would allow the Attorney General’s office to protect a hospital when it's struggling financially or operated in a “manner that is detrimental to patients,” Neronha said. 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 management services organization or similar entity responsible for administering a medical group’s contracts with health insurance carriers or third-party administrators. A public hearing on the regulation is scheduled for July 8. Neronha has also issued an advanced notice of proposed rulemaking to assess whether more regulation on the use of Artificial Intelligence is needed. A public hearing on this is scheduled for July 9. These 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 proposals.” More information on Neronha’s initiatives can be found at a new website his office created. Katie Castellani is a PBN staff writer. You may contact her at Castellani@PBN.com.