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Boston Globe

R.I.'s health care system is in a state of ‘spectacular failure,' attorney general says

Get Rhode Map A weekday briefing from veteran Rhode Island reporters, focused on the things that matter most in the Ocean State. Enter Email Sign Up 'If they don't, there will be one reason why not: because we haven't acted quickly enough,' the attorney general said. Advertisement 'If we have the courage to do what we're talking about today, we can drive down costs, enhance revenue, [and] give Rhode Islanders a health care system they deserve,' he added. On that list is proposed legislation to immediately increase Medicaid reimbursement rates to primary care providers so the rates are 100 percent 'on par with rates for Medicare,' officials said. The current Medicaid rate in Rhode Island is 37 percent of Medicare's rate — lower than it is in neighboring Massachusetts and Connecticut, Neronha said. Advertisement 'Low Medicaid reimbursement also undercuts our primary care providers by under compensating them for their services, and it makes it harder for Rhode Island to retain PCPs,' said Lee Staley, the health care unit chief for the Attorney General's Office. The bill, if approved, 'would allow for the state to leverage federal matching funds that are available in the Medicaid program, essentially letting the state's dollars stretch further,' Staley said. The initiative is estimated to cost around $50 million, according to Neronha. He said he has spoken with House Speaker K. Joseph Shekarchi about how to drum up the funding, but did not elaborate further. 'We have to stabilize primary care right now,' Neronha said. 'Primary care doctors are the air traffic controllers of our health care system. They're the ones that analyze our problem, send us to the tests we need, send us to the specialist we need.' Here are other actions Neronha outlined on Wednesday: A lawsuit against pharmacy benefit managers Rhode Island has filed a lawsuit in Providence County Superior Court against the country's largest pharmacy benefit managers — CVS Caremark, Express Scripts, and Optum — and their affiliated group purchasing organizations, Zinc, Ascent Health Services, Emisar Pharma Services. The lawsuit alleges that PBNs, which act as a third-party between health plans and drug manufacturers, 'deceive consumers by branding themselves as a source of cost-savings when in fact they profit directly from cost increases,' officials said. 'Often secretive and unknown to consumers, PBMs and GPOs exploit the complex scheme of pricing and payment for prescription drugs, and they take a cut of ever-increasing drug prices at every step of the way,' Neronha's office said. 'They may also make decisions about formularies — the lists of drugs that are available to plan enrollees — that unfairly restrict access to safe and effective medications.' Advertisement Proposed legislation and regulations Neronha's office has proposed legislation that, if passed, would make it unlawful for insurers to require prior authorization 'on any procedure, test, treatment, study or prescription drug ordered by a primary care provider, with exceptions for controlled substances and individual providers with identified cases of fraud, waste or abuse,' officials said. Another proposed bill would grant the attorney general the authority to petition the Superior Court to place a hospital into receivership — a process similar to bankruptcy in state court — if it is in 'financial distress or is otherwise being operated in a manner that is detrimental to patients,' Neronha's office said. Prosecutors are also eyeing regulations to require the attorney general's office be notified of 'certain material corporate transactions involving medical practice groups, including transactions involving private equity firms,' and are looking into how to possibly regulate the use of artificial intelligence in health care, officials said. Establishing a new state health care agency and Brown University collaboration The Attorney General's Office has also collaborated with the Brown University School of Public Health Center for Advancing Health Policy Through Research to 'examine potential policy options for state-based health system reform,' officials said. Additionally, Neronha said his office is proposing the creation of a new state-run health care agency that would work to collect data and make policy recommendations to improve Rhode Island's health care system. Officials anticipate a more complete proposal to be ready later this year, before the 2026 legislative session. 'We have come to the conclusion that the way we're doing health care isn't strategic — that that element of thinking doesn't exist in Rhode Island,' he said. Advertisement 'We can do better,' he added. Christopher Gavin can be reached at