Office of the Health Insurance Commissioner Releases Revised Affordability Standards

  • 01 Jul 2020

Rhode Island instituted health care "affordability standards" for commercial health insurers 10 years ago to encourage them to improve the affordability of their health plans, as well as enhance health care quality and consumer protections. Insurers were first directed to increase investment in the state's primary care health system, and then cap spending growth for hospitals and encourage the adoption of new provider payment models.


The Rhode Island Office of the Health Insurance Commissioner (OHIC) recently updated these standards. The new regulations continue the primary care funding requirement and add important new provisions designed to facilitate behavioral health integration and accelerate the adoption of payment reforms. New policies that have been adopted to support behavioral health care and promote its integration into primary care practices include:

  • A process for the state to recognize "qualifying integrated behavioral health (QIBH) primary care practices"
  • The elimination of copays for behavioral health services delivered in conjunction with a primary care visit in a QIBH primary care practice
  • Out-of-pocket costs for behavioral health screening services that are comparable to other health screenings
  • Insurer reports to OHIC regarding their strategies to support behavioral health integration in primary care

Rhode Island has now set aggressive targets and requirements for the use of alternative payment models. Click here to read more adapted by the June 23 Milbank Memorial Fund newsletter.