Potter, Ujifusa Bill Aims to Reduce Prior Authorization Requirements

Legislation would free PCPs from time-consuming roadblock to patient care

 

STATE HOUSE – Rep. Brandon Potter and Sen. Linda L. Ujifusa have introduced legislation to eliminate a barrier to health care by prohibiting health insurers from requiring prior authorization for treatment and services ordered by a patient’s primary care provider.

The legislation (2025-H 5120), which was introduced in the House and the Senate this week, is meant to help patients access the care they need in a timely manner while also decreasing the administrative burden on primary care providers (PCPs) so they can focus on patient care.

“Prior authorization is a tool used by insurance corporations to block patients from getting what their doctors ordered. It’s based on the false assumption that doctors and patients ‘over-utilize’ goods and services and need to be ‘managed’ by private insurers,” said Senator Ujifusa (D-Dist. 11, Portsmouth, Bristol). “In fact, requiring PCP prior authorizations delays or prevents patients from getting tests and treatments —making diseases harder to treat or requiring trips to the emergency room. This bill allows PCPs to spend more time caring for patients, not fighting for permission from corporations who profit from limiting care.”

Freeing PCPs from the tremendous administrative burdens posed by prior authorization requirements is particularly important as Rhode Island struggles with a shortage of PCPs.

“We know all too well that Rhode Islanders are struggling to find primary care doctors, and those fortunate enough to have one are facing longer waits for appointments. The situation is only made worse when doctors have to spend their time battling insurance companies instead of treating patients. This is a step to ease that burden, expand access to basic health care, and ensure medical decisions are made by doctors based on what’s best for patients — not by insurance companies prioritizing their bottom line,” said Representative Potter (D-Dist. 16, Cranston).

The legislation would prohibit insurers from imposing prior authorization requirements for any admission, item, service, treatment, or procedure ordered by an in-network primary care provider, including general internists, family physicians, pediatricians, geriatricians, OB-GYNs, nurse practitioners, physician assistants and other health care providers who are licensed to provide, coordinate, and supervise primary care and order health care services and goods, including preventive and diagnostic services for patients.

If approved, the bill would take effect July 1, 2026.

According to the American Medical Association, which has been advocating to reduce prior authorization requirements, the average physician practice completes 45 prior authorizations per physician per week. According to the most recent AMA survey, 94% of physicians believe prior authorization delays care.

The Rhode Island Medical Society has also advocated for reductions in prior authorization requirements.

“This legislation is a step in the right direction to address the significant challenges physicians face due to prior authorization requirements. These burdens delay care, increase administrative strain, and ultimately impact patient outcomes. We appreciate the leadership of Representative Potter and Senator Ujifusa in tackling this issue and remain committed to advocating for further reforms that support timely, patient-centered care” said Rhode Island Medical Society President Dr. Kara Stavros.

 

President Trump's "Big, Beautiful Bill" faces uncertainty in the House now that it's cleared the Senate. Republicans only have a thee vote majority in the House and the conservative Freedom Caucus strongly opposes any more increases in the federal deficit. House lawmakers have been told they could start voting on the GOP spending bill as soon as 9 a.m. Eastern Wednesday.        Millions in the Northeast are bracing for severe storms just ahead of the Fourth of July holiday. Forecasters say the I-95 corridor from New York to Washington, D.C. will likely see strong storms with damaging wind gusts exceeding 60 miles per hour possible. Flash flooding is possible from Maine all the way down to North Carolina, with Baltimore and D.C. seeing the highest level of threat.        President Trump says DOGE is a monster that could eat Elon Musk. Speaking to reporters, Trump said he'll "take a look" at deporting Musk, who is originally from South Africa. The President said Musk is upset that the electric vehicle mandate is being terminated and added not everybody wants an EV, including himself. The comments come after Musk sharply criticized Trump's Big Beautiful Bill and called for a new political party.        The suspect in the ambush murders of two Idaho firefighters apparently at one time wanted to be a firefighter himself. The Kootenai [[ koot-ten-nay ]] County Sheriff's Office says 20-year-old Wess Roley appeared to be living out of his car. Officers found a shotgun near his body following Sunday's attack that also left another first responder injured. They'd reportedly been lured to the area by Roley, who authorities believe intentionally set a small brush fire.        New York state Assembly member Zohran Mamdani is the Democratic nominee for mayor. The 33-year-old Democratic Socialist's official victory follows the release of the city's ranked choice voting results. Mamdani ran on a promise to make New York City more affordable after launching his campaign last fall. He will face off against sitting Mayor Eric Adams, who is running for reelection as an independent, as well as Republican nominee Curtis Sliwa and independent Jim Walden.        K-Pop superstars BTS will be releasing new music next spring as well as going out on a world tour. The super group has been on hiatus since 2022 while members completed mandatory military service in South Korea. Members also used the break to work on solo projects. BTS' last album released in 2022.