S2401

	2024 -- S 2401
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	LC004447
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	STATE OF RHODE ISLAND
	IN GENERAL ASSEMBLY
	JANUARY SESSION, A.D. 2024
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	A N A C T
	RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

	Introduced By: Senators DiPalma, and Miller
	Date Introduced: February 12, 2024
	Referred To: Senate Health & Human Services
	It is enacted by the General Assembly as follows:
1	SECTION 1. Chapter 27-18 of the General Laws entitled "Accident and Sickness Insurance
2	Policies" is hereby amended by adding thereto the following section:
3	27-18-95. Coverage for pharmacists' services.
4	(a) Every group health insurance contract, or every group hospital or medical expense
5	insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by
6	any health insurance carrier, on or after January 1, 2025, shall provide coverage for the services
7	within the lawful scope of practice of pharmacists pursuant to § 5-19.1-2, and pharmacists' services
8	provided under a collaborative agreement pursuant to § 5-19.2-2, if the plan would have provided
9	coverage if the service had been performed by a physician, advanced practice nurse, or physician
10	assistant . No nonprofit medical service corporation may require supervision, signature, or referral
11	by any other healthcare provider as a condition of reimbursement to a pharmacist; provided that,
12	no nonprofit medical service corporation may be required to pay for duplicative services actually
13	rendered by both a pharmacist and any other healthcare provider.
14	(b) The health plan must include an adequate number of pharmacists in its network of
15	participating medical providers. The participation of pharmacies in the plan network's drug benefit
16	does not satisfy the requirement that plans include pharmacists in their networks of participating
17	medical providers.
18	(c) The healthcare benefits outlined in this chapter apply only to services delivered within
19	the health insurer's provider network; provided that, all health insurers shall be required to provide

1	coverage for those benefits mandated by this chapter outside of the health insurer's provider
2	network where it can be established that the required services are not available from a provider in
3	the health insurer's network.
4	(d) The department of human services shall apply to the United States department of health
5	and human services for any amendment to the state Medicaid plan or for any Medicaid waiver as
6	necessary to implement this section. The department of human services shall submit the Medicaid
7	state plan amendment not later than September 1, 2024.
8	SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service
9	Corporations" is hereby amended by adding thereto the following section:
10	27-19-87. Coverage for pharmacists' services.
11	(a) Every group health insurance contract, or every group hospital or medical expense
12	insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by
13	any health insurance carrier, on or after January 1, 2025, shall provide coverage for the services
14	within the lawful scope of practice of pharmacists pursuant to § 5-19.1-2, and pharmacists' services
15	provided under a collaborative agreement pursuant to § 5-19.2-2, if the plan would have provided
16	coverage if the service had been performed by a physician, advanced practice nurse, or physician
17	assistant. No nonprofit medical service corporation may require supervision, signature, or referral
18	by any other healthcare provider as a condition of reimbursement to a pharmacist; provided that,
19	no nonprofit medical service corporation may be required to pay for duplicative services actually
20	rendered by both a pharmacist and any other healthcare provider.
21	(b) The health plan must include an adequate number of pharmacists in its network of
22	participating medical providers. The participation of pharmacies in the plan network's drug benefit
23	does not satisfy the requirement that plans include pharmacists in their networks of participating
24	medical providers.
25	(c) The healthcare benefits outlined in this chapter apply only to services delivered within
26	the health insurer's provider network; provided that, all health insurers shall be required to provide
27	coverage for those benefits mandated by this chapter outside of the health insurer's provider
28	network where it can be established that the required services are not available from a provider in
29	the health insurer's network.
30	(d) The department of human services shall apply to the United States department of health
31	and human services for any amendment to the state Medicaid plan or for any Medicaid waiver as
32	necessary to implement this section. The department of human services shall submit the Medicaid
33	state plan amendment not later than September 1, 2024.
34	SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service
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1	Corporations" is hereby amended by adding thereto the following section:
2	27-20-83. Coverage for pharmacists' services.
3	(a) Every group health insurance contract, or every group hospital or medical expense
4	insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by
5	any health insurance carrier, on or after January 1, 2025, shall provide coverage for the services
6	within the lawful scope of practice of pharmacists pursuant to § 5-19.1-2, and pharmacists' services
7	provided under a collaborative agreement pursuant to § 5-19.2-2, if the plan would have provided
8	coverage if the service had been performed by a physician, advanced practice nurse, or physician
9	assistant. No nonprofit medical service corporation may require supervision, signature, or referral
10	by any other healthcare provider as a condition of reimbursement to a pharmacist; provided that,
11	no nonprofit medical service corporation may be required to pay for duplicative services actually
12	rendered by both a pharmacist and any other healthcare provider.
13	(b) The health plan must include an adequate number of pharmacists in its network of
14	participating medical providers. The participation of pharmacies in the plan network's drug benefit
15	does not satisfy the requirement that plans include pharmacists in their networks of participating
16	medical providers.
17	(c) The healthcare benefits outlined in this chapter apply only to services delivered within
18	the health insurer's provider network; provided that, all health insurers shall be required to provide
19	coverage for those benefits mandated by this chapter outside of the health insurer's provider
20	network where it can be established that the required services are not available from a provider in
21	the health insurer's network.
22	(d) The department of human services shall apply to the United States department of health
23	and human services for any amendment to the state Medicaid plan or for any Medicaid waiver as
24	necessary to implement this section. The department of human services shall submit the Medicaid
25	state plan amendment not later than September 1, 2024.
26	SECTION 4. Chapter 27-41 of the General Laws entitled "Health Maintenance
27	Organizations" is hereby amended by adding thereto the following section:
28	27-41-100. Coverage for pharmacists' services.
29	(a) Every group health insurance contract, or every group hospital or medical expense
30	insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by
31	any health insurance carrier, on or after January 1, 2025, shall provide coverage for the services
32	within the lawful scope of practice of pharmacists pursuant to § 5-19.1-2, and pharmacists' services
33	provided under a collaborative agreement pursuant to § 5-19.2-2, if the plan would have provided
34	coverage if the service had been performed by a physician, advanced practice nurse, or physician
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1	assistant. No nonprofit medical service corporation may require supervision, signature, or referral
2	by any other healthcare provider as a condition of reimbursement to a pharmacist; provided that,
3	no nonprofit medical service corporation may be required to pay for duplicative services actually
4	rendered by both a pharmacist and any other healthcare provider.
5	(b) The health plan must include an adequate number of pharmacists in its network of
6	participating medical providers. The participation of pharmacies in the plan network's drug benefit
7	does not satisfy the requirement that plans include pharmacists in their networks of participating
8	medical providers.
9	(c) The healthcare benefits outlined in this chapter apply only to services delivered within
10	the health insurer's provider network; provided that, all health insurers shall be required to provide
11	coverage for those benefits mandated by this chapter outside of the health insurer's provider
12	network where it can be established that the required services are not available from a provider in
13	the health insurer's network.
14	(d) The department of human services shall apply to the United States department of health
15	and human services for any amendment to the state Medicaid plan or for any Medicaid waiver as
16	necessary to implement this section. The department of human services shall submit the Medicaid
17	state plan amendment not later than September 1, 2024.
18	SECTION 5. This act shall take effect on January 1, 2025.
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	EXPLANATION
	BY THE LEGISLATIVE COUNCIL
	OF
	A N A C T
	RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES
	***
1	This act would require insurance coverage for all services provided by a pharmacist
2	provided coverage of such services would have been covered if provided by a physician, advanced
3	practice nurse, or physician assistant. The health plan would be required to provide an adequate
4	number of pharmacists in its network of participating medical providers. This act would further
5	require the department of human services to apply to the United States department of health and
6	human services for any amendment to state Medicaid plan or any Medicaid waiver as necessary to
7	implement this act, no later than September 1, 2024.
8	This act would take effect on January 1, 2025.
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