Rhode Island 2025 Regular Session

Rhode Island House Bill H5627 Compare Versions

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

Old	New	Differences
1	1
2	2
3	3
4	4
5	5	2025 -- H 5627
6	6	========
7	7	LC001434
8	8	========
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 INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES
16	16	Introduced By: Representatives Casimiro, Noret, Read, Spears, McGaw, and Solomon
17	17	Date Introduced: February 26, 2025
18	18	Referred To: House Health & Human Services
19	19
20	20
21	21	It is enacted by the General Assembly as follows:
22	22	SECTION 1. Chapter 27-18 of the General Laws entitled "Accident and Sickness Insurance 1
23	23	Policies" is hereby amended by adding thereto the following section: 2
24	24	27-18-95. Coverage for pharmacists' services. 3
25	25	(a) Every group health insurance contract, or every group hospital or medical expense 4
26	26	insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by 5
27	27	any health insurance carrier, on or after January 1, 2026, shall provide coverage for the services 6
28	28	within the lawful scope of the "practice of pharmacy" defined in § 5-19.1-2, and pharmacists' 7
29	29	services provided under a "collaborative practice agreement" defined in § 5-19.2-2, if the plan 8
30	30	would have provided coverage if the service had been performed by a physician, advanced practice 9
31	31	nurse, or physician assistant. No nonprofit medical service corporation may require supervision, 10
32	32	signature, or referral by any other healthcare provider as a condition of reimbursement to a 11
33	33	pharmacist; provided that, no nonprofit medical service corporation may be required to pay for 12
34	34	duplicative services actually rendered by both a pharmacist and any other healthcare provider. The 13
35	35	following services shall qualify as being eligible for payment and reimbursement to a pharmacist, 14
36	36	unless paid by another mechanism, include: 15
37	37	(1) Evaluation and management of a patient, which requires a medically appropriate history 16
38	38	and/or examination and medical decision making; 17
39	39	(2) Medication therapy management review; 18
40	40	(3) Immunization education and administration; 19
41	41
42	42
43	43	LC001434 - Page 2 of 7
44	44	(4) Administration of medications; and 1
45	45	(5) Ordering and evaluation of clinical laboratory tests. 2
46	46	(b) The health plan shall include an adequate number of pharmacists in its network of 3
47	47	participating medical providers. The participation of pharmacies in the plan network's drug benefit 4
48	48	shall not satisfy the requirement that plans include pharmacists in their networks of participating 5
49	49	medical providers. 6
50	50	(c) The healthcare benefits outlined in this section apply only to services delivered within 7
51	51	the health insurer's provider network; provided that, all health insurers shall be required to provide 8
52	52	coverage for those benefits required by the provisions of this section outside of the health insurer's 9
53	53	provider network where it can be established that the required services are not available from a 10
54	54	provider in the health insurer's network. 11
55	55	(d) The provisions of this section shall sunset and expire on January 1, 2030, unless 12
56	56	extended by the general assembly. 13
57	57	SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service 14
58	58	Corporations" is hereby amended by adding thereto the following section: 15
59	59	27-19-87. Coverage for pharmacists' services. 16
60	60	(a) Every group health insurance contract, or every group hospital or medical expense 17
61	61	insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by 18
62	62	any health insurance carrier, on or after January 1, 2026, shall provide coverage for the services 19
63	63	within the lawful scope of the "practice of pharmacy" defined in § 5-19.1-2, and pharmacists' 20
64	64	services provided under a "collaborative practice agreement" defined in § 5-19.2-2, if the plan 21
65	65	would have provided coverage if the service had been performed by a physician, advanced practice 22
66	66	nurse, or physician assistant. No nonprofit medical service corporation may require supervision, 23
67	67	signature, or referral by any other healthcare provider as a condition of reimbursement to a 24
68	68	pharmacist; provided that, no nonprofit medical service corporation may be required to pay for 25
69	69	duplicative services actually rendered by both a pharmacist and any other healthcare provider. The 26
70	70	following services shall qualify as being eligible for payment and reimbursement to a pharmacist, 27
71	71	unless paid by another mechanism, include: 28
72	72	(1) Evaluation and management of a patient, which requires a medically appropriate history 29
73	73	and/or examination and medical decision making; 30
74	74	(2) Medication therapy management review; 31
75	75	(3) Immunization education and administration; 32
76	76	(4) Administration of medications; and 33
77	77	(5) Ordering and evaluation of clinical laboratory tests. 34
78	78
79	79
80	80	LC001434 - Page 3 of 7
81	81	(b) The health plan shall include an adequate number of pharmacists in its network of 1
82	82	participating medical providers. The participation of pharmacies in the plan network's drug benefit 2
83	83	shall not satisfy the requirement that plans include pharmacists in their networks of participating 3
84	84	medical providers. 4
85	85	(c) The healthcare benefits outlined in this section apply only to services delivered within 5
86	86	the health insurer's provider network; provided that, all health insurers shall be required to provide 6
87	87	coverage for those benefits required by the provisions of this section outside of the health insurer's 7
88	88	provider network where it can be established that the required services are not available from a 8
89	89	provider in the health insurer's network. 9
90	90	(d) The provisions of this section shall sunset and expire on January 1, 2030, unless 10
91	91	extended by the general assembly. 11
92	92	SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service 12
93	93	Corporations" is hereby amended by adding thereto the following section: 13
94	94	27-20-83. Coverage for pharmacists' services. 14
95	95	(a) Every group health insurance contract, or every group hospital or medical expense 15
96	96	insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by 16
97	97	any health insurance carrier, on or after January 1, 2026, shall provide coverage for the services 17
98	98	within the lawful scope of the "practice of pharmacy" defined in § 5-19.1-2, and pharmacists' 18
99	99	services provided under a "collaborative practice agreement" defined in § 5-19.2-2, if the plan 19
100	100	would have provided coverage if the service had been performed by a physician, advanced practice 20
101	101	nurse, or physician assistant. No nonprofit medical service corporation may require supervision, 21
102	102	signature, or referral by any other healthcare provider as a condition of reimbursement to a 22
103	103	pharmacist; provided that, no nonprofit medical service corporation may be required to pay for 23
104	104	duplicative services actually rendered by both a pharmacist and any other healthcare provider. The 24
105	105	following services shall qualify as being eligible for payment and reimbursement to a pharmacist, 25
106	106	unless paid by another mechanism, include: 26
107	107	(1) Evaluation and management of a patient, which requires a medically appropriate history 27
108	108	and/or examination and medical decision making; 28
109	109	(2) Medication therapy management review; 29
110	110	(3) Immunization education and administration; 30
111	111	(4) Administration of medications; and 31
112	112	(5) Ordering and evaluation of clinical laboratory tests. 32
113	113	(b) The health plan shall include an adequate number of pharmacists in its network of 33
114	114	participating medical providers. The participation of pharmacies in the plan network's drug benefit 34
115	115
116	116
117	117	LC001434 - Page 4 of 7
118	118	shall not satisfy the requirement that plans include pharmacists in their networks of participating 1
119	119	medical providers. 2
120	120	(c) The healthcare benefits outlined in this section apply only to services delivered within 3
121	121	the health insurer's provider network; provided that, all health insurers shall be required to provide 4
122	122	coverage for those benefits required by the provisions of this section outside of the health insurer's 5
123	123	provider network where it can be established that the required services are not available from a 6
124	124	provider in the health insurer's network. 7
125	125	(d) The provisions of this section shall sunset and expire on January 1, 2030, unless 8
126	126	extended by the general assembly. 9
127	127	SECTION 4. Chapter 27-41 of the General Laws entitled "Health Maintenance 10
128	128	Organizations" is hereby amended by adding thereto the following section: 11
129	129	27-41-100. Coverage for pharmacists' services. 12
130	130	(a) Every group health insurance contract, or every group hospital or medical expense 13
131	131	insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by 14
132	132	any health insurance carrier, on or after January 1, 2026, shall provide coverage for the services 15
133	133	within the lawful scope of the "practice of pharmacy" defined in § 5-19.1-2, and pharmacists' 16
134	134	services provided under a "collaborative practice agreement" defined in § 5-19.2-2, if the plan 17
135	135	would have provided coverage if the service had been performed by a physician, advanced practice 18
136	136	nurse, or physician assistant. No nonprofit medical service corporation may require supervision, 19
137	137	signature, or referral by any other healthcare provider as a condition of reimbursement to a 20
138	138	pharmacist; provided that, no nonprofit medical service corporation may be required to pay for 21
139	139	duplicative services actually rendered by both a pharmacist and any other healthcare provider. The 22
140	140	following services shall qualify as being eligible for payment and reimbursement to a pharmacist, 23
141	141	unless paid by another mechanism, include: 24
142	142	(1) Evaluation and management of a patient, which requires a medically appropriate history 25
143	143	and/or examination and medical decision making; 26
144	144	(2) Medication therapy management review; 27
145	145	(3) Immunization education and administration; 28
146	146	(4) Administration of medications; and 29
147	147	(5) Ordering and evaluation of clinical laboratory tests. 30
148	148	(b) The health plan shall include an adequate number of pharmacists in its network of 31
149	149	participating medical providers. The participation of pharmacies in the plan network's drug benefit 32
150	150	shall not satisfy the requirement that plans include pharmacists in their networks of participating 33
151	151	medical providers. 34
152	152
153	153
154	154	LC001434 - Page 5 of 7
155	155	(c) The healthcare benefits outlined in this section apply only to services delivered within 1
156	156	the health insurer's provider network; provided that, all health insurers shall be required to provide 2
157	157	coverage for those benefits required by the provisions of this section outside of the health insurer's 3
158	158	provider network where it can be established that the required services are not available from a 4
159	159	provider in the health insurer's network. 5
160	160	(d) The provisions of this section shall sunset and expire on January 1, 2030, unless 6
161	161	extended by the general assembly. 7
162	162	SECTION 5. Chapter 40-8 of the General Laws entitled "Medical Assistance" is hereby 8
163	163	amended by adding thereto the following section: 9
164	164	40-8-33. Coverage for pharmacists' services. 10
165	165	(a) The executive office of health and human services is directed and authorized to establish 11
166	166	coverage for the services within the lawful scope of the "practice of pharmacy" defined in § 5-19.1-12
167	167	2, and pharmacists' services provided under a "collaborative practice agreement" defined in § 5-13
168	168	19.2-2, if the plan would have provided coverage if the service had been performed by a physician, 14
169	169	advanced practice nurse, or physician assistant. The following services would qualify as being 15
170	170	eligible for payment and reimbursement to a pharmacist, unless paid by another mechanism, 16
171	171	include: 17
172	172	(1) Evaluation and management of a patient, which requires a medically appropriate history 18
173	173	and/or examination and medical decision making; 19
174	174	(2) Medication therapy management review; 20
175	175	(3) Immunization education and administration; 21
176	176	(4) Administration of medications; and 22
177	177	(5) Ordering and evaluation of clinical laboratory tests. 23
178	178	(b) The health plan shall include pharmacists in its network of participating medical 24
179	179	providers. The participation of pharmacies in the plan network's drug benefit shall not satisfy the 25
180	180	requirement that plans include pharmacists in their networks of participating medical providers. 26
181	181	(c) The healthcare benefits outlined in this section apply only to services delivered within 27
182	182	the health insurer's provider network; provided that, all health insurers shall be required to provide 28
183	183	coverage for those benefits required by the provisions of this section outside of the health insurer's 29
184	184	provider network where it can be established that the required services are not available from a 30
185	185	provider in the health insurer's network. 31
186	186	(d) The executive office of health and department of human services shall apply to the 32
187	187	United States department of health and human services for any amendment to the state Medicaid 33
188	188	plan or for any Medicaid waiver as necessary to implement this section. The executive office of 34
189	189
190	190
191	191	LC001434 - Page 6 of 7
192	192	health and human services shall submit the Medicaid state plan amendment not later than 1
193	193	September 1, 2025. 2
194	194	(e) The provisions of this section shall sunset and expire on January 1, 2030, unless 3
195	195	extended by the general assembly. 4
196	196	SECTION 6. This act shall take effect on January 1, 2026, and unless extended by the 5
197	197	general assembly, shall expire on January 1, 2030. 6
198	198	========
199	199	LC001434
200	200	========
201	201
202	202
203	203	LC001434 - Page 7 of 7
204	204	EXPLANATION
205	205	BY THE LEGISLATIVE COUNCIL
206	206	OF
207	207	A N A C T
208	208	RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES
209	209	***
210	210	This act would require health insurance providers to provide insurance coverage for 1
211	211	pharmacists’ services including evaluation and management of a patient, which requires a 2
212	212	medically appropriate history and/or examination and medical decision making; medication 3
213	213	therapy management review; immunization education and administration; administration of 4
214	214	medications; ordering and evaluation of clinical laboratory tests. 5
215	215	This act would take effect on January 1, 2026, and unless extended by the general assembly, 6
216	216	would expire on January 1, 2030. 7
217	217	========
218	218	LC001434
219	219	========