2025 -- H 6117
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LC002543
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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
____________
A N A C T
RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES
Introduced By: Representatives Tanzi, Potter, Cruz, Morales, Kislak, Diaz, Casimiro,
McGaw, and Felix
Date Introduced: March 21, 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. Community health workers. 3
(a) As used in this section, “community health worker” means a trained professional 4
providing services that are considered medically necessary for patients with one or more chronic 5
health, including behavioral health, conditions, patients who are at risk for a chronic health 6
condition, and/or who face barriers meeting their health or health-related social needs. Services that 7
can be provided by community health workers can include, but are not limited to: 8
(1) Health and promotion coaching; 9
(2) Health education and training; 10
(3) Health system navigation and resource coordination services; 11
(4) Care planning; and 12
(5) Follow-up care recommendations. 13
(b)(1) Every individual or group health insurance contract, or every individual or group 14
hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, 15
or renewed in this state on or after January 1, 2026, shall provide coverage for the services of a 16
community health worker in accordance with each health insurer's respective principles and 17
mechanisms of reimbursement, credentialing, and contracting, if the services are within the 18
community health worker's area of professional competence as defined by the community health 19
LC002543 - Page 2 of 8
worker certification standard developed and maintained by the Rhode Island certification board in 1
collaboration with the department of health, and are currently reimbursed when rendered by any 2
other healthcare provider. 3
(2) No insurer or hospital or medical service corporation may require supervision, 4
signature, or referral by any other healthcare provider as a condition of reimbursement, except when 5
those requirements are also applicable to other categories of healthcare providers. 6
(3) No insurer or hospital or medical service corporation or patient may be required to pay 7
for duplicate services actually rendered by both a community health worker and any other 8
healthcare provider. 9
(c) Every individual or group health insurance contract, or every individual or group 10
hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, 11
or renewed in this state that is required to cover community health worker services as defined in 12
subsections (a) and (b) of this section, shall report utilization and cost information related to 13
community health worker services to the office of the health insurance commissioner on or before 14
July 1, 2027 and each July 1 thereafter. The office of the health insurance commissioner shall define 15
the utilization and cost information required to be reported. 16
(d) This section shall not apply to insurance coverage providing benefits for: 17
(1) Hospital confinement indemnity; 18
(2) Disability income; 19
(3) Accident only; 20
(4) Long-term care; 21
(5) Limited benefit health; 22
(6) Specified disease indemnity; 23
(7) Sickness or bodily injury or death by accident or both; and 24
(8) Other limited benefit policies. 25
SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service 26
Corporations" is hereby amended by adding thereto the following section: 27
27-19-87. Community health workers. 28
(a) As used in this section, “community health worker” means a trained professional 29
providing services that are considered medically necessary for patients with one or more chronic 30
health, including behavioral health, conditions, patients who are at risk for a chronic health 31
condition, and/or who face barriers meeting their health or health-related social needs. Services that 32
can be provided by community health workers can include, but are not limited to: 33
(1) Health and promotion coaching; 34
LC002543 - Page 3 of 8
(2) Health education and training; 1
(3) Health system navigation and resource coordination services; 2
(4) Care planning; and 3
(5) Follow-up care recommendations. 4
(b)(1) Every individual or group health insurance contract, or every individual or group 5
hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, 6
or renewed in this state on or after January 1, 2026, shall provide coverage for the services of a 7
community health worker in accordance with each health insurer's respective principles and 8
mechanisms of reimbursement, credentialing, and contracting, if the services are within the 9
community health worker's area of professional competence as defined by the community health 10
worker certification standard developed and maintained by the Rhode Island certification board in 11
collaboration with the department of health, and are currently reimbursed when rendered by any 12
other healthcare provider. 13
(2) No insurer or hospital or medical service corporation may require supervision, 14
signature, or referral by any other healthcare provider as a condition of reimbursement, except when 15
those requirements are also applicable to other categories of healthcare providers. 16
(3) No insurer or hospital or medical service corporation or patient may be required to pay 17
for duplicate services actually rendered by both a community health worker and any other 18
healthcare provider. 19
(c) Every individual or group health insurance contract, or every individual or group 20
hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, 21
or renewed in this state that is required to cover community health worker services as defined in 22
subsections (a) and (b) of this section, shall report utilization and cost information related to 23
community health worker services to the office of the health insurance commissioner on or before 24
July 1, 2027 and each July 1 thereafter. The office of the health insurance commissioner shall define 25
the utilization and cost information required to be reported. 26
(d) This section shall not apply to insurance coverage providing benefits for: 27
(1) Hospital confinement indemnity; 28
(2) Disability income; 29
(3) Accident only; 30
(4) Long-term care; 31
(5) Limited benefit health; 32
(6) Specified disease indemnity; 33
(7) Sickness or bodily injury or death by accident or both; and 34
LC002543 - Page 4 of 8
(8) Other limited benefit policies. 1
SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service 2
Corporations" is hereby amended by adding thereto the following section: 3
27-20-83. Community health workers. 4
(a) As used in this section, “community health worker” means a trained professional 5
providing services that are considered medically necessary for patients with one or more chronic 6
health, including behavioral health, conditions, patients who are at risk for a chronic health 7
condition, and/or who face barriers meeting their health or health-related social needs. Services that 8
can be provided by community health workers can include, but are not limited to: 9
(1) Health and promotion coaching; 10
(2) Health education and training; 11
(3) Health system navigation and resource coordination services; 12
(4) Care planning; and 13
(5) Follow-up care recommendations. 14
(b)(1) Every individual or group health insurance contract, or every individual or group 15
hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, 16
or renewed in this state on or after January 1, 2026, shall provide coverage for the services of a 17
community health worker in accordance with each health insurer's respective principles and 18
mechanisms of reimbursement, credentialing, and contracting, if the services are within the 19
community health worker's area of professional competence as defined by the community health 20
worker certification standard developed and maintained by the Rhode Island certification board in 21
collaboration with the department of health, and are currently reimbursed when rendered by any 22
other healthcare provider. 23
(2) No insurer or hospital or medical service corporation may require supervision, 24
signature, or referral by any other healthcare provider as a condition of reimbursement, except when 25
those requirements are also applicable to other categories of healthcare providers. 26
(3) No insurer or hospital or medical service corporation or patient may be required to pay 27
for duplicate services actually rendered by both a community health worker and any other 28
healthcare provider. 29
(c) Every individual or group health insurance contract, or every individual or group 30
hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, 31
or renewed in this state that is required to cover community health worker services as defined in 32
subsections (a) and (b) of this section, shall report utilization and cost information related to 33
community health worker services to the office of the health insurance commissioner on or before 34
LC002543 - Page 5 of 8
July 1, 2027 and each July 1 thereafter. The office of the health insurance commissioner shall define 1
the utilization and cost information required to be reported. 2
(d) This section shall not apply to insurance coverage providing benefits for: 3
(1) Hospital confinement indemnity; 4
(2) Disability income; 5
(3) Accident only; 6
(4) Long-term care; 7
(5) Limited benefit health; 8
(6) Specified disease indemnity; 9
(7) Sickness or bodily injury or death by accident or both; and 10
(8) Other limited benefit policies. 11
SECTION 4. Chapter 27-41 of the General Laws entitled "Health Maintenance 12
Organizations" is hereby amended by adding thereto the following section: 13
27-41-100. Community health workers. 14
(a) As used in this section, “community health worker” means a trained professional 15
providing services that are considered medically necessary for patients with one or more chronic 16
health, including behavioral health, conditions, patients who are at risk for a chronic health 17
condition, and/or who face barriers meeting their health or health-related social needs. Services that 18
can be provided by community health workers can include, but are not limited to: 19
(1) Health and promotion coaching; 20
(2) Health education and training; 21
(3) Health system navigation and resource coordination services; 22
(4) Care planning; and 23
(5) Follow-up care recommendations. 24
(b)(1) Every individual or group health insurance contract, or every individual or group 25
hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, 26
or renewed in this state on or after January 1, 2026, shall provide coverage for the services of a 27
community health worker in accordance with each health insurer's respective principles and 28
mechanisms of reimbursement, credentialing, and contracting, if the services are within the 29
community health worker's area of professional competence as defined by the community health 30
worker certification standard developed and maintained by the Rhode Island certification board in 31
collaboration with the department of health, and are currently reimbursed when rendered by any 32
other healthcare provider. 33
(2) No insurer or hospital or medical service corporation may require supervision, 34
LC002543 - Page 6 of 8
signature, or referral by any other healthcare provider as a condition of reimbursement, except when 1
those requirements are also applicable to other categories of healthcare providers. 2
(3) No insurer or hospital or medical service corporation or patient may be required to pay 3
for duplicate services actually rendered by both a community health worker and any other 4
healthcare provider. 5
(c) Every individual or group health insurance contract, or every individual or group 6
hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, 7
or renewed in this state that is required to cover community health worker services as defined in 8
subsections (a) and (b) of this section, shall report utilization and cost information related to 9
community health worker services to the office of the health insurance commissioner on or before 10
July 1, 2027 and each July 1 thereafter. The office of the health insurance commissioner shall define 11
the utilization and cost information required to be reported. 12
(d) This section shall not apply to insurance coverage providing benefits for: 13
(1) Hospital confinement indemnity; 14
(2) Disability income; 15
(3) Accident only; 16
(4) Long-term care; 17
(5) Limited benefit health; 18
(6) Specified disease indemnity; 19
(7) Sickness or bodily injury or death by accident or both; and 20
(8) Other limited benefit policies. 21
SECTION 5. Chapter 27-18.2 of the General Laws entitled "Medicare Supplement 22
Insurance Policies" is hereby amended by adding thereto the following section: 23
27-18.2-12. Community health workers. 24
(a) As used in this section. "community health worker" means a trained professional 25
providing services that are considered medically necessary for patients with one or more chronic 26
health, including behavioral health, conditions, patients who are at risk for a chronic health 27
condition, and/or who face barriers meeting their health or health-related social needs. Services that 28
can be provided by community health workers can include. but are not limited to: 29
(1) Health and promotion coaching; 30
(2) Health education and training; 31
(3) Health system navigation and resource coordination services; 32
(4) Care planning; and 33
(5) Follow-up care recommendations. 34
LC002543 - Page 7 of 8
(b)(l) Every individual or group health insurance contract, or every individual or group 1
hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, 2
or renewed in this state on or after January 1, 2026, shall provide coverage for the services of a 3
community health worker in accordance with each health insurer's respective principles and 4
mechanisms of reimbursement, credentialing, and contracting, if the services are within the 5
community health worker's area of professional competence as defined by the community health 6
worker certification standard developed and maintained by the Rhode Island certification board in 7
collaboration with the department of health, and are currently reimbursed when rendered by any 8
other healthcare provider. 9
(2) No insurer or hospital or medical service corporation may require supervision, 10
signature, or referral by any other healthcare provider as a condition of reimbursement, except when 11
those requirements are also applicable to other categories of healthcare providers. 12
(3) No insurer or hospital or medical service corporation or patient may be required to pay 13
for duplicate services actually rendered by both a community health worker and any other 14
healthcare provider. 15
(c) Every individual or group health insurance contract, or every individual or group 16
hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, 17
or renewed in this state that is required to cover community health worker services as defined in 18
subsections (a) and (b) of this section, shall report utilization and cost information related to 19
community health worker services to the office of the health insurance commissioner on or before 20
July 1, 2027 and each July 1 thereafter. The office of the health insurance commissioner shall define 21
the utilization and cost information required to be reported. 22
(d) This section shall not apply to insurance coverage providing benefits for: 23
(1) Hospital confinement indemnity; 24
(2) Disability income; 25
(3) Accident only; 26
(4) Long-term care; 27
(5) Limited benefit health; 28
(6) Specified disease indemnity; 29
(7) Sickness or bodily injury or death by accident or both; and 30
(8) Other limited benefit policies. 31
SECTION 6. This act shall take effect on January 1, 2026. 32
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LC002543
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LC002543 - Page 8 of 8
EXPLANATION
BY THE LEGISLATIVE COUNCIL
OF
A N A C T
RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES
***
This act would require insurance coverage for all community health workers’ services to 1
include, but not be limited to, health and promotion coaching, health education and training, health 2
system navigation and resource coordination services, care planning and follow-up care 3
recommendations. Coverage would not be provided for insurance coverage providing benefits for 4
hospital confinement indemnity, disability income, accident only, long-term care, Medicare 5
supplement, limited benefit health, specified disease indemnity, sickness or bodily injury or death 6
by accident, or both, and other limited benefit policies. 7
This act would take effect on January 1, 2026. 8
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LC002543
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