Rhode Island 2025 Regular Session

Rhode Island House Bill H5107 Compare Versions

Only one version of the bill is available at this time.

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5	5	2025 -- H 5107
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7	7	LC000095
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9	9	S T A T E O F R H O D E I S L A N D
10	10	IN GENERAL ASSEMBLY
11	11	JANUARY SESSION, A.D. 2025
12	12	____________
13	13
14	14	A N A C T
15	15	RELATING TO COMMERCI AL LAW -- GENERAL REGULATORY PROVISION S --
16	16	PATIENT BROKERING ACT
17	17	Introduced By: Representatives J. Lombardi, Hull, Potter, Voas, and Felix
18	18	Date Introduced: January 22, 2025
19	19	Referred To: House Corporations
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22	22	It is enacted by the General Assembly as follows:
23	23	SECTION 1. Title 6 of the General Laws entitled "COMMERCIAL LAW -- GENERAL 1
24	24	REGULATORY PROVISIONS" is hereby amended by adding thereto the following chapter: 2
25	25	CHAPTER 13.4 3
26	26	PATIENT BROKERING ACT 4
27	27	6-13.4-1. Definitions. 5
28	28	The following words as used in this chapter, unless a different meaning is required by the 6
29	29	context or is specifically prescribed, shall have the following meanings: 7
30	30	(1) "Health care provider" means any person or entity licensed, certified, or registered; 8
31	31	required to be licensed, certified or registered; or lawfully exempt from being required to be 9
32	32	licensed, certified or registered with the department of health; any person or entity that has 10
33	33	contracted with the department of health to provide goods or services to Medicaid recipients 11
34	34	pursuant to Rhode Island law; any provider of behavioral health care services provided by the 12
35	35	department of behavioral health care, developmental disabilities and hospitals; or any federally 13
36	36	supported primary care program authorized under 42 U.S.C. Chapter 6A, "Public Health Service." 14
37	37	(2) "Health care provider network entity" means a corporation, partnership, or limited 15
38	38	liability company owned or operated by two (2) or more health care providers and organized for 16
39	39	the purpose of entering into agreements with health insurers, health care purchasing groups, or the 17
40	40	Medicare or Medicaid program. 18
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44	44	(3) "Health insurer" means any insurance company authorized to transact health insurance 1
45	45	in the state, any insurance company authorized to transact health insurance or casualty insurance in 2
46	46	the state that is offering a minimum premium plan or stop-loss coverage for any person or entity 3
47	47	providing health care benefits, any self-insurance plan as defined in title 27, any health maintenance 4
48	48	organization, any prepaid health clinic, any prepaid limited health service organization, any 5
49	49	multiple-employer welfare arrangement authorized to transact business in the state pursuant to title 6
50	50	27, or any fraternal benefit society lawfully providing health benefits to its members. 7
51	51	6-13.4-2. Patient brokering prohibited. 8
52	52	It is an unfair sales practice for any person, including any health care provider or health 9
53	53	care facility, to: 10
54	54	(1) Offer or pay a commission, benefit, bonus, rebate, kickback, or bribe, directly or 11
55	55	indirectly, in cash or in kind, or engage in any split-fee arrangement, in any form whatsoever, to 12
56	56	induce the referral of a patient or patronage to or from a health care provider or health care facility; 13
57	57	(2) Solicit or receive a commission, benefit, bonus, rebate, kickback, or bribe, directly or 14
58	58	indirectly, in cash or in kind, or engage in any split-fee arrangement, in any form whatsoever, in 15
59	59	return for referring a patient or patronage to or from a health care provider or health care facility; 16
60	60	(3) Solicit or receive a commission, benefit, bonus, rebate, kickback, or bribe, directly or 17
61	61	indirectly, in cash or in kind, or engage in any split-fee arrangement, in any form whatsoever, in 18
62	62	return for the acceptance or acknowledgement of treatment from a health care provider or health 19
63	63	care facility; or 20
64	64	(4) Aid, abet, advise, or otherwise participate in the conduct prohibited under this section. 21
65	65	6-13.4-3. Exceptions. 22
66	66	This chapter shall not apply to: 23
67	67	(1) Any discount, payment, waiver of payment, or payment practice not prohibited by 42 24
68	68	U.S.C. § 1320a-7b(b) or regulations promulgated thereunder. 25
69	69	(2) Any payment, compensation, or financial arrangement within a group practice, 26
70	70	provided such payment, compensation, or arrangement is not to or from persons who are not 27
71	71	members of the group practice. 28
72	72	(3) Payments to a health care provider or health care facility for professional consultation 29
73	73	services. 30
74	74	(4) Commissions, fees, or other remuneration lawfully paid to insurance agents as provided 31
75	75	under title 27. 32
76	76	(5) Payments by a health insurer who reimburses, provides, offers to provide, or 33
77	77	administers health, mental health, or substance abuse goods or services under a health benefit plan. 34
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81	81	(6) Payments to or by a health care provider or health care facility, or a health care provider 1
82	82	network entity, that has contracted with a health insurer, a health care purchasing group, or the 2
83	83	Medicare or Medicaid program to provide health, metal health, or substance abuse goods or 3
84	84	services under a health benefit plan when such payments are for goods or services under the plan; 4
85	85	provided however, that nothing in this section shall affect whether a health care provider network 5
86	86	entity is an insurer required to be licensed under Rhode Island law. 6
87	87	(7) Insurance advertising gifts lawfully permitted under title 27. 7
88	88	(8) When applicable, commissions or fees paid to a nurse registry licensed pursuant to the 8
89	89	department of health for referring persons providing health care services to clients of the nurse 9
90	90	registry. 10
91	91	(9) Payments by a health care provider or health care facility to a health, mental health, or 11
92	92	substance abuse information service that provides information upon request and without charge to 12
93	93	consumers about providers of health care goods or services to enable consumers to select 13
94	94	appropriate providers or facilities, provided that, such information service: 14
95	95	(i) Does not attempt through its standard questions for solicitation of consumer criteria or 15
96	96	through any other means to steer or lead a consumer to select or consider selection of a particular 16
97	97	health care provider or health care facility; 17
98	98	(ii) Does not provide or represent itself as providing diagnostic or counseling services or 18
99	99	assessments of illness or injury and does not make any promises of cure or guarantees of treatment; 19
100	100	(iii) Does not provide or arrange for transportation of a consumer to or from the location 20
101	101	of a health care provider or health care facility; and 21
102	102	(iv) Charges and collects fees from a health care provider or health care facility 22
103	103	participating in its services that are set in advance, are consistent with the fair market value for 23
104	104	those information services, and are not based on the potential value of a patient or patients to a 24
105	105	health care provider or health care facility or of the goods or services provided by the health care 25
106	106	provider or health care facility. 26
107	107	(10) An individual employed by the assisted living facility, or with whom the facility 27
108	108	contracts to provide marketing services for the facility, if the individual clearly indicates that they 28
109	109	work with or for the facility. 29
110	110	(11) Payments by an assisted living facility to a referral service that provides information, 30
111	111	consultation, or referrals to consumers to assist them in finding appropriate care or housing options 31
112	112	for seniors or disabled adults if the referred consumers are not Medicaid recipients. 32
113	113	(12) A resident of an assisted living facility who refers a friend, family members, or other 33
114	114	individuals with whom the resident has a personal relationship to the assisted living facility, in 34
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118	118	which case the assisted living facility may provide a monetary reward to the resident for making 1
119	119	such referral. 2
120	120	6-13.4-4. Penalties - Enforcement. 3
121	121	(a) Any person, including an officer, partner, agent, attorney or other representative of a 4
122	122	firm, joint venture, partnership, business trust, syndicate, corporation, or other business entity, who 5
123	123	violates any provision of this chapter commits a felony and shall, in addition to any criminal 6
124	124	sentence imposed, be ordered to pay a fine of fifty thousand dollars ($50,000) for a violation 7
125	125	involving fewer than ten (10) patients; one hundred thousand dollars ($100,000) for a violation 8
126	126	involving between ten (10) and fewer than twenty (20) patients; and five hundred thousand dollars 9
127	127	($500,000) for any violation where the prohibited conduct involves twenty (20) or more patients. 10
128	128	(b) Notwithstanding the existence or pursuit of any other remedy, the Rhode Island attorney 11
129	129	general may maintain an action for injunctive or other process to enforce the provisions of this 12
130	130	chapter. 13
131	131	(c) The party bringing an action under this chapter may recover reasonable expenses in 14
132	132	obtaining injunctive relief, including, but not limited to, investigative costs, court costs, reasonable 15
133	133	attorneys' fees, witness costs, and deposition expenses. 16
134	134	(d) The provisions of this chapter are in addition to any other civil, administrative, or 17
135	135	criminal actions provided by law and may be imposed against both corporate and individual 18
136	136	defendants. 19
137	137	SECTION 2. This act shall take effect upon passage. 20
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144	144	EXPLANATION
145	145	BY THE LEGISLATIVE COUNCIL
146	146	OF
147	147	A N A C T
148	148	RELATING TO COMMERCI AL LAW -- GENERAL REGULATORY PROVISIONS --
149	149	PATIENT BROKERING ACT
150	150	***
151	151	This act would prohibit the practice of patient brokering and would provide monetary 1
152	152	penalties and enforcement by the office of the attorney general. 2
153	153	This act would take effect upon passage. 3
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