PROVIDENCE — In 2017, The Health Care Accessibility and Quality Assurance Act switched jurisdiction for health insurance network plans from the R.I. Department of Health to the Office of Health Insurance Commissioner, effective Jan. 1, 2018, and new regulation fine-tuning the authority is open to public comment, with a public hearing Sept. 19.
Public comment on the regulation, posted to the R.I. Department of Regulation, closes Oct. 5.
Cory King, principal policy planner for OHIC, said the office has been supervising the plans since the law took effect under the statute. However, he said, the regulations will allow them greater control over how they work with insurers.
Among the regulations is the requirement that prior to formula changes in a network plan, a health care entity must:
- Provide 30 calendar days’ notice to prescribers of the affected medications and adversely affected beneficiaries must be given 30 calendar days notice before the effective date of change.
- Maintain an on-going monitoring process to assure its provider network for each of its network plans provide sufficient scope and access.
- Establish a process to appeal a denial of access to out-of-network providers and additional cost charges imposed beyond in-network coverage.
The comment and review of the regulation should take about 30 days if no one comments or objects to the proposed rules, he said. If a critique arises that leads to change in the regulation, the process may take as many as 45 days to finish, King said.
Written comments on the regulation, or requests for more information, can be sent to:
Alyssa R. Metivier
Department of Business Regulation (includes the Office of the Health Insurance Commissioner)
Office of the Health Insurance Commissioner
1511 Pontiac Ave
Cranston, RI 02920
alyssa.metivier@ohic.ri.gov
The public hearing on Sept. 19 will be held at 1 p.m. at the Department of Business Regulation/OHIC, Conference Room 691, 1511 Pontiac Ave, Building 69, Cranston.
Rob Borkowski is a PBN staff writer. Email him at Borkowski@PBN.com.
