2025 -- H 5256
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LC000780
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S T A T E O F R H O D E I S L A N D
IN GENERAL ASSEMBLY
JANUARY SESSION, A.D. 2025
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A N A C T
RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES--
EQUAL PAY FOR HEALTH CARE PROVIDERS
Introduced By: Representatives Casimiro, Noret, Read, McEntee, Spears, Shanley, and
Morales
Date Introduced: January 31, 2025
Referred To: House Health & Human Services
It is enacted by the General Assembly as follows:
SECTION 1. Chapter 27-18 of the General Laws entitled "Accident and Sickness Insurance 1
Policies" is hereby amended by adding thereto the following section: 2
27-18-95. Equal pay for healthcare providers. 3
(a) Whenever any policy of health insurance provides for reimbursement for any service 4
which is within the lawful scope of practice of a duly licensed and certified nurse practitioner, as 5
defined in § 5-34-3, including prescribing or dispensing drugs, a primary care or mental health 6
service, provided by a licensed physician, the insured under the policy is entitled to reimbursement 7
for such service, whether it is performed by a physician licensed by the board of medical licensure 8
and discipline or by a duly licensed nurse practitioner, if provided by a licensed physician assistant, 9
as defined in chapter 54 of title 5 or a certified nurse practitioner, or other licensed healthcare 10
professionals, as defined in § 27-18-1.1, if the service is within the lawful scope of practice of the 11
physician assistant or nurse practitioner. 12
(b) The reimbursement of a service described in subsection (a) of this section that is 13
provided by a licensed physician assistant or a certified nurse practitioner who is in an independent 14
practice shall be in the same amount as the reimbursement paid under the policy to a licensed 15
physician performing the service in the area served. 16
(c) As used in this section, “independent practice” means the provision of healthcare 17
services to patients in a setting in which the licensed physician assistant or the certified nurse 18
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practitioner bills insurers for services identified by diagnosis and procedure codes using the 1
physician assistant’s or nurse practitioner’s own name and national provider identifier. 2
(d) This section does not apply to group practice health maintenance organizations that are 3
federally qualified pursuant to Title XIII of the Health Maintenance Organization Act, or other 4
insurers that employ physicians, licensed physician assistants or certified nurse practitioners to 5
provide primary care or mental health services and do not compensate such practitioners on a fee-6
for-service basis. 7
(e) An insurer may not reduce the reimbursement paid to a licensed physician in order to 8
comply with this section. 9
SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service 10
Corporations" is hereby amended by adding thereto the following section: 11
27-19-87. Equal pay for healthcare providers. 12
(a) Whenever any policy of health insurance provides for reimbursement for any service 13
which is within the lawful scope of practice of a duly licensed and certified nurse practitioner, as 14
defined in § 5-34-3, including prescribing or dispensing drugs, a primary care or mental health 15
service, provided by a licensed physician, the insured under the policy is entitled to reimbursement 16
for such service, whether it is performed by a physician licensed by the board of medical licensure 17
and discipline or by a duly licensed nurse practitioner, if provided by a licensed physician assistant, 18
as defined in chapter 54 of title 5 or a certified nurse practitioner, or other licensed healthcare 19
professionals, as defined in § 27-18-1.1, if the service is within the lawful scope of practice of the 20
physician assistant or nurse practitioner. 21
(b) The reimbursement of a service described in subsection (a) of this section that is 22
provided by a licensed physician assistant or a certified nurse practitioner who is in an independent 23
practice shall be in the same amount as the reimbursement paid under the policy to a licensed 24
physician performing the service in the area served. 25
(c) As used in this section, “independent practice” means the provision of healthcare 26
services to patients in a setting in which the licensed physician assistant or the certified nurse 27
practitioner bills insurers for services identified by diagnosis and procedure codes using the 28
physician assistant’s or nurse practitioner’s own name and national provider identifier. 29
(d) This section does not apply to group practice health maintenance organizations that are 30
federally qualified pursuant to Title XIII of the Health Maintenance Organization Act, or other 31
insurers that employ physicians, licensed physician assistants or certified nurse practitioners to 32
provide primary care or mental health services and do not compensate such practitioners on a fee-33
for-service basis. 34
LC000780 - Page 3 of 4
(e) An insurer may not reduce the reimbursement paid to a licensed physician in order to 1
comply with this section. 2
SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service 3
Corporations" is hereby amended by adding thereto the following section: 4
27-20-83. Equal pay for healthcare providers. 5
(a) Whenever any policy of health insurance provides for reimbursement for any service 6
which is within the lawful scope of practice of a duly licensed and certified nurse 7
practitioner, as defined in § 5-34-3, including prescribing or dispensing drugs, a primary care or 8
mental health service, provided by a licensed physician, the insured under the policy is entitled to 9
reimbursement for such service, whether it is performed by a physician licensed by the board of 10
medical licensure and discipline or by a duly licensed nurse practitioner, if provided by a licensed 11
physician assistant, as defined in chapter 54 of title 5 or a certified nurse practitioner, or other 12
licensed healthcare professionals, as defined in § 27-18-1.1, if the service is within the lawful scope 13
of practice of the physician assistant or nurse practitioner. 14
(b) The reimbursement of a service described in subsection (a) of this section that is 15
provided by a licensed physician assistant or a certified nurse practitioner who is in an independent 16
practice shall be in the same amount as the reimbursement paid under the policy to a licensed 17
physician performing the service in the area served. 18
(c) As used in this section, “independent practice” means the provision of healthcare 19
services to patients in a setting in which the licensed physician assistant or the certified nurse 20
practitioner bills insurers for services identified by diagnosis and procedure codes using the 21
physician assistant’s or nurse practitioner’s own name and national provider identifier. 22
(d) This section does not apply to group practice health maintenance organizations that are 23
federally qualified pursuant to Title XIII of the Health Maintenance Organization Act, or other 24
insurers that employ physicians, licensed physician assistants or certified nurse practitioners to 25
provide primary care or mental health services and do not compensate such practitioners on a fee-26
for-service basis. 27
(e) An insurer may not reduce the reimbursement paid to a licensed physician in order to 28
comply with this section. 29
SECTION 4. This act shall take effect on January 1, 2026. 30
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EXPLANATION
BY THE LEGISLATIVE COUNCIL
OF
A N A C T
RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES--
EQUAL PAY FOR HEALTH CARE PROVIDERS
***
This act would provide for equal pay for healthcare providers. 1
This act would take effect on January 1, 2026. 2
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