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| 4 | 4 | | |
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| 5 | 5 | | 2025 -- S 0705 |
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| 6 | 6 | | ======== |
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| 7 | 7 | | LC001159 |
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| 8 | 8 | | ======== |
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| 9 | 9 | | S T A T E O F R H O D E I S L A N D |
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| 10 | 10 | | IN GENERAL ASSEMBLY |
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| 11 | 11 | | JANUARY SESSION, A.D. 2025 |
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| 12 | 12 | | ____________ |
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| 13 | 13 | | |
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| 14 | 14 | | A N A C T |
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| 15 | 15 | | RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES |
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| 16 | 16 | | Introduced By: Senators DiMario, Valverde, Lauria, Lawson, Bissaillon, Acosta, Murray, |
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| 17 | 17 | | Euer, and Kallman |
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| 18 | 18 | | Date Introduced: March 07, 2025 |
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| 19 | 19 | | Referred To: Senate Health & Human Services |
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| 20 | 20 | | |
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| 21 | 21 | | |
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| 22 | 22 | | It is enacted by the General Assembly as follows: |
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| 23 | 23 | | SECTION 1. Chapter 27-18 of the General Laws entitled "Accident and Sickness Insurance 1 |
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| 24 | 24 | | Policies" is hereby amended by adding thereto the following section: 2 |
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| 25 | 25 | | 27-18-95. Community health workers. 3 |
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| 26 | 26 | | (a) As used in this section, “community health worker” means a trained professional 4 |
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| 27 | 27 | | providing services that are considered medically necessary for patients with one or more chronic 5 |
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| 28 | 28 | | health, including behavioral health, conditions, patients who are at risk for a chronic health 6 |
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| 29 | 29 | | condition, and/or who face barriers meeting their health or health-related social needs. Services that 7 |
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| 30 | 30 | | can be provided by community health workers can include, but are not limited to: 8 |
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| 31 | 31 | | (1) Health and promotion coaching; 9 |
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| 32 | 32 | | (2) Health education and training; 10 |
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| 33 | 33 | | (3) Health system navigation and resource coordination services; 11 |
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| 34 | 34 | | (4) Care planning; and 12 |
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| 35 | 35 | | (5) Follow-up care recommendations. 13 |
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| 36 | 36 | | (b)(1) Every individual or group health insurance contract, or every individual or group 14 |
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| 37 | 37 | | hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, 15 |
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| 38 | 38 | | or renewed in this state on or after January 1, 2026, shall provide coverage for the services of a 16 |
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| 39 | 39 | | community health worker in accordance with each health insurer's respective principles and 17 |
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| 40 | 40 | | mechanisms of reimbursement, credentialing, and contracting, if the services are within the 18 |
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| 41 | 41 | | community health worker's area of professional competence as defined by the community health 19 |
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| 42 | 42 | | |
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| 43 | 43 | | |
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| 44 | 44 | | LC001159 - Page 2 of 8 |
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| 45 | 45 | | worker certification standard developed and maintained by the Rhode Island certification board in 1 |
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| 46 | 46 | | collaboration with the department of health, and are currently reimbursed when rendered by any 2 |
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| 47 | 47 | | other healthcare provider. 3 |
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| 48 | 48 | | (2) No insurer or hospital or medical service corporation may require supervision, 4 |
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| 49 | 49 | | signature, or referral by any other healthcare provider as a condition of reimbursement, except when 5 |
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| 50 | 50 | | those requirements are also applicable to other categories of healthcare providers. 6 |
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| 51 | 51 | | (3) No insurer or hospital or medical service corporation or patient may be required to pay 7 |
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| 52 | 52 | | for duplicate services actually rendered by both a community health worker and any other 8 |
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| 53 | 53 | | healthcare provider. 9 |
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| 54 | 54 | | (c) Every individual or group health insurance contract, or every individual or group 10 |
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| 55 | 55 | | hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, 11 |
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| 56 | 56 | | or renewed in this state that is required to cover community health worker services as defined in 12 |
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| 57 | 57 | | subsections (a) and (b) of this section, shall report utilization and cost information related to 13 |
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| 58 | 58 | | community health worker services to the office of the health insurance commissioner on or before 14 |
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| 59 | 59 | | July 1, 2027 and each July 1 thereafter. The office of the health insurance commissioner shall define 15 |
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| 60 | 60 | | the utilization and cost information required to be reported. 16 |
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| 61 | 61 | | (d) This section shall not apply to insurance coverage providing benefits for: 17 |
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| 62 | 62 | | (1) Hospital confinement indemnity; 18 |
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| 63 | 63 | | (2) Disability income; 19 |
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| 64 | 64 | | (3) Accident only; 20 |
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| 65 | 65 | | (4) Long-term care; 21 |
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| 66 | 66 | | (5) Limited benefit health; 22 |
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| 67 | 67 | | (6) Specified disease indemnity; 23 |
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| 68 | 68 | | (7) Sickness or bodily injury or death by accident or both; and 24 |
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| 69 | 69 | | (8) Other limited benefit policies. 25 |
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| 70 | 70 | | SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service 26 |
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| 71 | 71 | | Corporations" is hereby amended by adding thereto the following section: 27 |
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| 72 | 72 | | 27-19-87. Community health workers. 28 |
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| 73 | 73 | | (a) As used in this section, “community health worker” means a trained professional 29 |
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| 74 | 74 | | providing services that are considered medically necessary for patients with one or more chronic 30 |
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| 75 | 75 | | health, including behavioral health, conditions, patients who are at risk for a chronic health 31 |
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| 76 | 76 | | condition, and/or who face barriers meeting their health or health-related social needs. Services that 32 |
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| 77 | 77 | | can be provided by community health workers can include, but are not limited to: 33 |
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| 78 | 78 | | (1) Health and promotion coaching; 34 |
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| 79 | 79 | | |
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| 80 | 80 | | |
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| 81 | 81 | | LC001159 - Page 3 of 8 |
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| 82 | 82 | | (2) Health education and training; 1 |
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| 83 | 83 | | (3) Health system navigation and resource coordination services; 2 |
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| 84 | 84 | | (4) Care planning; and 3 |
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| 85 | 85 | | (5) Follow-up care recommendations. 4 |
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| 86 | 86 | | (b)(1) Every individual or group health insurance contract, or every individual or group 5 |
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| 87 | 87 | | hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, 6 |
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| 88 | 88 | | or renewed in this state on or after January 1, 2026, shall provide coverage for the services of a 7 |
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| 89 | 89 | | community health worker in accordance with each health insurer's respective principles and 8 |
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| 90 | 90 | | mechanisms of reimbursement, credentialing, and contracting, if the services are within the 9 |
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| 91 | 91 | | community health worker's area of professional competence as defined by the community health 10 |
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| 92 | 92 | | worker certification standard developed and maintained by the Rhode Island certification board in 11 |
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| 93 | 93 | | collaboration with the department of health, and are currently reimbursed when rendered by any 12 |
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| 94 | 94 | | other healthcare provider. 13 |
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| 95 | 95 | | (2) No insurer or hospital or medical service corporation may require supervision, 14 |
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| 96 | 96 | | signature, or referral by any other healthcare provider as a condition of reimbursement, except when 15 |
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| 97 | 97 | | those requirements are also applicable to other categories of healthcare providers. 16 |
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| 98 | 98 | | (3) No insurer or hospital or medical service corporation or patient may be required to pay 17 |
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| 99 | 99 | | for duplicate services actually rendered by both a community health worker and any other 18 |
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| 100 | 100 | | healthcare provider. 19 |
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| 101 | 101 | | (c) Every individual or group health insurance contract, or every individual or group 20 |
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| 102 | 102 | | hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, 21 |
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| 103 | 103 | | or renewed in this state that is required to cover community health worker services as defined in 22 |
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| 104 | 104 | | subsections (a) and (b) of this section, shall report utilization and cost information related to 23 |
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| 105 | 105 | | community health worker services to the office of the health insurance commissioner on or before 24 |
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| 106 | 106 | | July 1, 2027 and each July 1 thereafter. The office of the health insurance commissioner shall define 25 |
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| 107 | 107 | | the utilization and cost information required to be reported. 26 |
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| 108 | 108 | | (d) This section shall not apply to insurance coverage providing benefits for: 27 |
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| 109 | 109 | | (1) Hospital confinement indemnity; 28 |
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| 110 | 110 | | (2) Disability income; 29 |
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| 111 | 111 | | (3) Accident only; 30 |
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| 112 | 112 | | (4) Long-term care; 31 |
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| 113 | 113 | | (5) Limited benefit health; 32 |
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| 114 | 114 | | (6) Specified disease indemnity; 33 |
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| 115 | 115 | | (7) Sickness or bodily injury or death by accident or both; and 34 |
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| 116 | 116 | | |
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| 117 | 117 | | |
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| 118 | 118 | | LC001159 - Page 4 of 8 |
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| 119 | 119 | | (8) Other limited benefit policies. 1 |
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| 120 | 120 | | SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service 2 |
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| 121 | 121 | | Corporations" is hereby amended by adding thereto the following section: 3 |
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| 122 | 122 | | 27-20-83. Community health workers. 4 |
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| 123 | 123 | | (a) As used in this section, “community health worker” means a trained professional 5 |
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| 124 | 124 | | providing services that are considered medically necessary for patients with one or more chronic 6 |
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| 125 | 125 | | health, including behavioral health, conditions, patients who are at risk for a chronic health 7 |
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| 126 | 126 | | condition, and/or who face barriers meeting their health or health-related social needs. Services that 8 |
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| 127 | 127 | | can be provided by community health workers can include, but are not limited to: 9 |
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| 128 | 128 | | (1) Health and promotion coaching; 10 |
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| 129 | 129 | | (2) Health education and training; 11 |
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| 130 | 130 | | (3) Health system navigation and resource coordination services; 12 |
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| 131 | 131 | | (4) Care planning; and 13 |
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| 132 | 132 | | (5) Follow-up care recommendations. 14 |
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| 133 | 133 | | (b)(1) Every individual or group health insurance contract, or every individual or group 15 |
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| 134 | 134 | | hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, 16 |
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| 135 | 135 | | or renewed in this state on or after January 1, 2026, shall provide coverage for the services of a 17 |
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| 136 | 136 | | community health worker in accordance with each health insurer's respective principles and 18 |
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| 137 | 137 | | mechanisms of reimbursement, credentialing, and contracting, if the services are within the 19 |
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| 138 | 138 | | community health worker's area of professional competence as defined by the community health 20 |
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| 139 | 139 | | worker certification standard developed and maintained by the Rhode Island certification board in 21 |
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| 140 | 140 | | collaboration with the department of health, and are currently reimbursed when rendered by any 22 |
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| 141 | 141 | | other healthcare provider. 23 |
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| 142 | 142 | | (2) No insurer or hospital or medical service corporation may require supervision, 24 |
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| 143 | 143 | | signature, or referral by any other healthcare provider as a condition of reimbursement, except when 25 |
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| 144 | 144 | | those requirements are also applicable to other categories of healthcare providers. 26 |
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| 145 | 145 | | (3) No insurer or hospital or medical service corporation or patient may be required to pay 27 |
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| 146 | 146 | | for duplicate services actually rendered by both a community health worker and any other 28 |
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| 147 | 147 | | healthcare provider. 29 |
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| 148 | 148 | | (c) Every individual or group health insurance contract, or every individual or group 30 |
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| 149 | 149 | | hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, 31 |
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| 150 | 150 | | or renewed in this state that is required to cover community health worker services as defined in 32 |
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| 151 | 151 | | subsections (a) and (b) of this section, shall report utilization and cost information related to 33 |
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| 152 | 152 | | community health worker services to the office of the health insurance commissioner on or before 34 |
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| 153 | 153 | | |
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| 154 | 154 | | |
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| 155 | 155 | | LC001159 - Page 5 of 8 |
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| 156 | 156 | | July 1, 2027 and each July 1 thereafter. The office of the health insurance commissioner shall define 1 |
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| 157 | 157 | | the utilization and cost information required to be reported. 2 |
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| 158 | 158 | | (d) This section shall not apply to insurance coverage providing benefits for: 3 |
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| 159 | 159 | | (1) Hospital confinement indemnity; 4 |
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| 160 | 160 | | (2) Disability income; 5 |
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| 161 | 161 | | (3) Accident only; 6 |
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| 162 | 162 | | (4) Long-term care; 7 |
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| 163 | 163 | | (5) Limited benefit health; 8 |
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| 164 | 164 | | (6) Specified disease indemnity; 9 |
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| 165 | 165 | | (7) Sickness or bodily injury or death by accident or both; and 10 |
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| 166 | 166 | | (8) Other limited benefit policies. 11 |
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| 167 | 167 | | SECTION 4. Chapter 27-41 of the General Laws entitled "Health Maintenance 12 |
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| 168 | 168 | | Organizations" is hereby amended by adding thereto the following section: 13 |
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| 169 | 169 | | 27-41-100. Community health workers. 14 |
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| 170 | 170 | | (a) As used in this section, “community health worker” means a trained professional 15 |
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| 171 | 171 | | providing services that are considered medically necessary for patients with one or more chronic 16 |
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| 172 | 172 | | health, including behavioral health, conditions, patients who are at risk for a chronic health 17 |
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| 173 | 173 | | condition, and/or who face barriers meeting their health or health-related social needs. Services that 18 |
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| 174 | 174 | | can be provided by community health workers can include, but are not limited to: 19 |
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| 175 | 175 | | (1) Health and promotion coaching; 20 |
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| 176 | 176 | | (2) Health education and training; 21 |
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| 177 | 177 | | (3) Health system navigation and resource coordination services; 22 |
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| 178 | 178 | | (4) Care planning; and 23 |
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| 179 | 179 | | (5) Follow-up care recommendations. 24 |
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| 180 | 180 | | (b)(1) Every individual or group health insurance contract, or every individual or group 25 |
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| 181 | 181 | | hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, 26 |
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| 182 | 182 | | or renewed in this state on or after January 1, 2026, shall provide coverage for the services of a 27 |
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| 183 | 183 | | community health worker in accordance with each health insurer's respective principles and 28 |
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| 184 | 184 | | mechanisms of reimbursement, credentialing, and contracting, if the services are within the 29 |
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| 185 | 185 | | community health worker's area of professional competence as defined by the community health 30 |
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| 186 | 186 | | worker certification standard developed and maintained by the Rhode Island certification board in 31 |
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| 187 | 187 | | collaboration with the department of health, and are currently reimbursed when rendered by any 32 |
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| 188 | 188 | | other healthcare provider. 33 |
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| 189 | 189 | | (2) No insurer or hospital or medical service corporation may require supervision, 34 |
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| 190 | 190 | | |
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| 191 | 191 | | |
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| 192 | 192 | | LC001159 - Page 6 of 8 |
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| 193 | 193 | | signature, or referral by any other healthcare provider as a condition of reimbursement, except when 1 |
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| 194 | 194 | | those requirements are also applicable to other categories of healthcare providers. 2 |
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| 195 | 195 | | (3) No insurer or hospital or medical service corporation or patient may be required to pay 3 |
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| 196 | 196 | | for duplicate services actually rendered by both a community health worker and any other 4 |
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| 197 | 197 | | healthcare provider. 5 |
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| 198 | 198 | | (c) Every individual or group health insurance contract, or every individual or group 6 |
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| 199 | 199 | | hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, 7 |
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| 200 | 200 | | or renewed in this state that is required to cover community health worker services as defined in 8 |
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| 201 | 201 | | subsections (a) and (b) of this section, shall report utilization and cost information related to 9 |
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| 202 | 202 | | community health worker services to the office of the health insurance commissioner on or before 10 |
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| 203 | 203 | | July 1, 2027 and each July 1 thereafter. The office of the health insurance commissioner shall define 11 |
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| 204 | 204 | | the utilization and cost information required to be reported. 12 |
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| 205 | 205 | | (d) This section shall not apply to insurance coverage providing benefits for: 13 |
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| 206 | 206 | | (1) Hospital confinement indemnity; 14 |
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| 207 | 207 | | (2) Disability income; 15 |
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| 208 | 208 | | (3) Accident only; 16 |
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| 209 | 209 | | (4) Long-term care; 17 |
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| 210 | 210 | | (5) Limited benefit health; 18 |
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| 211 | 211 | | (6) Specified disease indemnity; 19 |
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| 212 | 212 | | (7) Sickness or bodily injury or death by accident or both; and 20 |
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| 213 | 213 | | (8) Other limited benefit policies. 21 |
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| 214 | 214 | | SECTION 5. Chapter 27-18.2 of the General Laws entitled "Medicare Supplement 22 |
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| 215 | 215 | | Insurance Policies" is hereby amended by adding thereto the following section: 23 |
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| 216 | 216 | | 27-18.2-12. Community health workers. 24 |
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| 217 | 217 | | (a) As used in this section. "community health worker" means a trained professional 25 |
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| 218 | 218 | | providing services that are considered medically necessary for patients with one or more chronic 26 |
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| 219 | 219 | | health, including behavioral health, conditions, patients who are at risk for a chronic health 27 |
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| 220 | 220 | | condition, and/or who face barriers meeting their health or health-related social needs. Services that 28 |
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| 221 | 221 | | can be provided by community health workers can include. but are not limited to: 29 |
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| 222 | 222 | | (1) Health and promotion coaching; 30 |
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| 223 | 223 | | (2) Health education and training; 31 |
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| 224 | 224 | | (3) Health system navigation and resource coordination services; 32 |
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| 225 | 225 | | (4) Care planning; and 33 |
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| 226 | 226 | | (5) Follow-up care recommendations. 34 |
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| 227 | 227 | | |
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| 228 | 228 | | |
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| 229 | 229 | | LC001159 - Page 7 of 8 |
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| 230 | 230 | | (b)(l) Every individual or group health insurance contract, or every individual or group 1 |
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| 231 | 231 | | hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, 2 |
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| 232 | 232 | | or renewed in this state on or after January 1, 2026, shall provide coverage for the services of a 3 |
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| 233 | 233 | | community health worker in accordance with each health insurer's respective principles and 4 |
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| 234 | 234 | | mechanisms of reimbursement, credentialing, and contracting, if the services are within the 5 |
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| 235 | 235 | | community health worker's area of professional competence as defined by the community health 6 |
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| 236 | 236 | | worker certification standard developed and maintained by the Rhode Island certification board in 7 |
|---|
| 237 | 237 | | collaboration with the department of health, and are currently reimbursed when rendered by any 8 |
|---|
| 238 | 238 | | other healthcare provider. 9 |
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| 239 | 239 | | (2) No insurer or hospital or medical service corporation may require supervision, 10 |
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| 240 | 240 | | signature, or referral by any other healthcare provider as a condition of reimbursement, except when 11 |
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| 241 | 241 | | those requirements are also applicable to other categories of healthcare providers. 12 |
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| 242 | 242 | | (3) No insurer or hospital or medical service corporation or patient may be required to pay 13 |
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| 243 | 243 | | for duplicate services actually rendered by both a community health worker and any other 14 |
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| 244 | 244 | | healthcare provider. 15 |
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| 245 | 245 | | (c) Every individual or group health insurance contract, or every individual or group 16 |
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| 246 | 246 | | hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, 17 |
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| 247 | 247 | | or renewed in this state that is required to cover community health worker services as defined in 18 |
|---|
| 248 | 248 | | subsections (a) and (b) of this section, shall report utilization and cost information related to 19 |
|---|
| 249 | 249 | | community health worker services to the office of the health insurance commissioner on or before 20 |
|---|
| 250 | 250 | | July 1, 2027 and each July 1 thereafter. The office of the health insurance commissioner shall define 21 |
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| 251 | 251 | | the utilization and cost information required to be reported. 22 |
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| 252 | 252 | | (d) This section shall not apply to insurance coverage providing benefits for: 23 |
|---|
| 253 | 253 | | (1) Hospital confinement indemnity; 24 |
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| 254 | 254 | | (2) Disability income; 25 |
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| 255 | 255 | | (3) Accident only; 26 |
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| 256 | 256 | | (4) Long-term care; 27 |
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| 257 | 257 | | (5) Limited benefit health; 28 |
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| 258 | 258 | | (6) Specified disease indemnity; 29 |
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| 259 | 259 | | (7) Sickness or bodily injury or death by accident or both; and 30 |
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| 260 | 260 | | (8) Other limited benefit policies. 31 |
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| 261 | 261 | | SECTION 6. This act shall take effect on January 1, 2026. 32 |
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| 262 | 262 | | ======== |
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| 263 | 263 | | LC001159 |
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| 264 | 264 | | ======== |
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| 265 | 265 | | |
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| 266 | 266 | | |
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| 267 | 267 | | LC001159 - Page 8 of 8 |
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| 268 | 268 | | EXPLANATION |
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| 269 | 269 | | BY THE LEGISLATIVE COUNCIL |
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| 270 | 270 | | OF |
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| 271 | 271 | | A N A C T |
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| 272 | 272 | | RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES |
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| 273 | 273 | | *** |
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| 274 | 274 | | This act would require insurance coverage for all community health workers’ services to 1 |
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| 275 | 275 | | include, but not be limited to, health and promotion coaching, health education and training, health 2 |
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| 276 | 276 | | system navigation and resource coordination services, care planning and follow-up care 3 |
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| 277 | 277 | | recommendations. Coverage would not be provided for insurance coverage providing benefits for 4 |
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| 278 | 278 | | hospital confinement indemnity, disability income, accident only, long-term care, Medicare 5 |
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| 279 | 279 | | supplement, limited benefit health, specified disease indemnity, sickness or bodily injury or death 6 |
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| 280 | 280 | | by accident, or both, and other limited benefit policies. 7 |
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| 281 | 281 | | This act would take effect on January 1, 2026. 8 |
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| 282 | 282 | | ======== |
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| 283 | 283 | | LC001159 |
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| 284 | 284 | | ======== |
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| 285 | 285 | | |
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