Attorney General Neronha issues statement on OHIC’s missed opportunity to increase access to primary care through bold decrease of prior authorization

Published on Thursday, March 13, 2025

Attorney General Peter F. Neronha today issued a statement in response to a decision by the Rhode Island Office of the Health Insurance Commissioner (OHIC) against incorporating bolder proposed amendments to its regulations governing primary care. 

“Fixing our health care system requires bold policy changes that address what is broken, and OHIC’s refusal to seize this opportunity is a shame,” said Attorney General Neronha. “The Commissioner is uniquely positioned to effectuate substantial progress in health care policy. In November 2024, my Office urged OHIC to consider proposing a higher reduction in prior authorization requirements, which are extremely and needlessly burdensome for primary care physicians. The vast majority of prior authorizations result in approvals, making them a nearly unnecessary formality, the cost of which greatly overshadows the benefit. A significant reduction of this administrative red tape is low hanging fruit that would yield big results. Doctors would have more time to see more patients, and lower prior authorization requirements would be an attractive selling point for physicians to set up shop in Rhode Island at a time when many of them are understandably seeking to practice elsewhere. Yet here, the Commissioner ultimately declined the opportunity to move the needle in any significant way, choosing consensus over reform.”

“That said, the Commissioner alone cannot save us from this crisis, nor is reducing prior authorization a silver bullet,” continued Attorney General Neronha. “I urge leadership at every level to treat this as an emergency, and act accordingly. There must be coordinated efforts to first understand the full scope of Rhode Island’s health care crisis, and then to provide precise, data-driven solutions. Our residents, our hospitals, our doctors, they all feel the negative effects of a health care system teetering on the edge of disaster. We must not waste one more second.”

Today’s statement follows a public comment letter submitted by the Attorney General in November 2024 in which he urged OHIC to consider stronger proposed amendments to mitigate the negative effects on the provision of health care caused by unnecessary and burdensome prior authorization requirements. Instead, OHIC declined to require higher than a 20% reduction in prior authorization and failed to explain how a 20% reduction would provide meaningful relief to providers and consumers, other than pointing to insurance companies’ stance that 20% was an agreeable target.

Prior authorization is a process by which insurance companies require physicians to get approval before prescribed treatment, test, or medical service qualifies for payment. Insurers justify prior authorization by claiming it prevents unnecessary or too-expensive treatment. Historically, insurers narrowly applied prior authorization to higher cost services, but over time payors have expanded its use with the increased cost of care. Now, many frequently used tests, including radiology, require prior authorization. Many doctors argue that prior authorization is unnecessary, creates an abundant administrative burden, and attempts to replace clinical judgment with financial gatekeeping.

In a 2024 survey of its national members, the American Medical Association (AMA) found that prior authorization:

• Adds significant burden – Physicians reported completing an average 39 prior authorizations per week, which accounts for 13 hours of physician or staff time. This is 13 hours per week diverted from seeing patients.
• Harms patient care – Of providers surveyed, 93% said that prior authorization delays necessary care, 77% reported that prior authorization resulted in ineffective initial treatment, and 73% said prior authorization resulted in additional office visits. Additionally, more than one in four physicians reported that prior authorization has led to a serious adverse event for a patient in their care.
• Increases burnout – Prior authorization caused burnout in 89% of surveyed physicians.
• Increased costs to the health care system – Of physicians surveyed, 88% reported that prior authorization leads to higher overall utilization of the health care system. This increased utilization results in higher costs to the system that might otherwise have been avoided.   

On March 6, 2025, OHIC released the finalized version of its proposed change to the regulation. The proposed regulatory change sets out to 1) require insurers in the commercial market to reduce prior authorization by 20% and create a host of reporting requirements, 2) increase insurer investment in primary care, and 3) make a handful of technical changes to the regulation. Although the Attorney General agrees that these are the correct goals, OHIC’s regulation severely lacks the aggressive action the Office urged the Commissioner to take. Most notably, regarding prior authorization, the Attorney General encouraged 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. 

Specifically, the Attorney General urged 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. 

Read the full public comment letter here.

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