2024 -- S 2606 SUBSTITUTE A

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LC004893/SUB A/2

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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 DiMario, Miller, Lauria, Cano, Valverde, and Lawson

     Date Introduced: March 01, 2024

     Referred To: Senate 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

Policies" is hereby amended by adding thereto the following section:

     27-18-95. Community health workers.

     (a) As used in this section, “community health worker” means a trained professional

providing services that are considered medically necessary for patients with one or more chronic

health, including behavioral health, conditions, patients who are at risk for a chronic health

condition, and/or who face barriers meeting their health or health-related social needs. Services that

can be provided by community health workers can include, but are not limited to:

     (1) Health and promotion coaching;

     (2) Health education and training;

     (3) Health system navigation and resource coordination services;

     (4) Care planning; and

     (5) Follow-up care recommendations.

     (b)(1) Every individual or group health insurance contract, or every individual or group

hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery,

or renewed in this state on or after January 1, 2025, shall provide coverage for the services of a

community health worker in accordance with each health insurer's respective principles and

mechanisms of reimbursement, credentialing, and contracting, if the services are within the

community health worker's area of professional competence as defined by the community health

worker certification standard developed and maintained by the Rhode Island certification board in

collaboration with the department of health, and are currently reimbursed when rendered by any

other healthcare provider.

     (2) No insurer or hospital or medical service corporation may require supervision,

signature, or referral by any other healthcare provider as a condition of reimbursement, except when

those requirements are also applicable to other categories of healthcare providers.

     (3) No insurer or hospital or medical service corporation or patient may be required to pay

for duplicate services actually rendered by both a community health worker and any other

healthcare provider.

     (c) Every individual or group health insurance contract, or every individual or group

hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery,

or renewed in this state that is required to cover perinatal community health worker services as

defined in subsections (a) and (b) of this section, shall report utilization and cost information related

to community health worker services to the office of the health insurance commissioner on or

before July 1, 2026 and each July 1 thereafter. The office of the health insurance commissioner

shall define the utilization and cost information required to be reported.

     (d) This section shall not apply to insurance coverage providing benefits for:

     (1) Hospital confinement indemnity;

     (2) Disability income;

     (3) Accident only;

     (4) Long-term care;

     (5) Limited benefit health;

     (6) Specified disease indemnity;

     (7) Sickness or bodily injury or death by accident or both; and

     (8) Other limited benefit policies.

     SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service

Corporations" is hereby amended by adding thereto the following section:

     27-19-87. Community health workers.

     (a) As used in this section, “community health worker” means a trained professional

providing services that are considered medically necessary for patients with one or more chronic

health, including behavioral health, conditions, patients who are at risk for a chronic health

condition, and/or who face barriers meeting their health or health-related social needs. Services that

can be provided by community health workers can include, but are not limited to:

     (1) Health and promotion coaching;

LC004893/SUB A/2 - Page 2 of 7

     (2) Health education and training;

     (3) Health system navigation and resource coordination services;

     (4) Care planning; and

     (5) Follow-up care recommendations.

     (b)(1) Every individual or group health insurance contract, or every individual or group

hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery,

or renewed in this state on or after January 1, 2025, shall provide coverage for the services of a

community health worker in accordance with each health insurer's respective principles and

mechanisms of reimbursement, credentialing, and contracting, if the services are within the

community health worker's area of professional competence as defined by the community health

worker certification standard developed and maintained by the Rhode Island certification board in

collaboration with the department of health, and are currently reimbursed when rendered by any

other healthcare provider.

     (2) No insurer or hospital or medical service corporation may require supervision,

signature, or referral by any other healthcare provider as a condition of reimbursement, except when

those requirements are also applicable to other categories of healthcare providers.

     (3) No insurer or hospital or medical service corporation or patient may be required to pay

for duplicate services actually rendered by both a community health worker and any other

healthcare provider.

     (c) Every individual or group health insurance contract, or every individual or group

hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery,

or renewed in this state that is required to cover perinatal community health worker services as

defined in subsections (a) and (b) of this section, shall report utilization and cost information related

to community health worker services to the office of the health insurance commissioner on or

before July 1, 2026 and each July 1 thereafter. The office of the health insurance commissioner

shall define the utilization and cost information required to be reported.

     (d) This section shall not apply to insurance coverage providing benefits for:

     (1) Hospital confinement indemnity;

     (2) Disability income;

     (3) Accident only;

     (4) Long-term care;

     (5) Limited benefit health;

     (6) Specified disease indemnity;

     (7) Sickness or bodily injury or death by accident or both; and

LC004893/SUB A/2 - Page 3 of 7

     (8) Other limited benefit policies.

     SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service

Corporations" is hereby amended by adding thereto the following section:

     27-20-83. Community health workers.

     (a) As used in this section, “community health worker” means a trained professional

providing services that are considered medically necessary for patients with one or more chronic

health, including behavioral health, conditions, patients who are at risk for a chronic health

condition, and/or who face barriers meeting their health or health-related social needs. Services that

can be provided by community health workers can include, but are not limited to:

     (1) Health and promotion coaching;

     (2) Health education and training;

     (3) Health system navigation and resource coordination services;

     (4) Care planning; and

     (5) Follow-up care recommendations.

     (b)(1) Every individual or group health insurance contract, or every individual or group

hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery,

or renewed in this state on or after January 1, 2025, shall provide coverage for the services of a

community health worker in accordance with each health insurer's respective principles and

mechanisms of reimbursement, credentialing, and contracting, if the services are within the

community health worker's area of professional competence as defined by the community health

worker certification standard developed and maintained by the Rhode Island certification board in

collaboration with the department of health, and are currently reimbursed when rendered by any

other healthcare provider.

     (2) No insurer or hospital or medical service corporation may require supervision,

signature, or referral by any other healthcare provider as a condition of reimbursement, except when

those requirements are also applicable to other categories of healthcare providers.

     (3) No insurer or hospital or medical service corporation or patient may be required to pay

for duplicate services actually rendered by both a community health worker and any other

healthcare provider.

     (c) Every individual or group health insurance contract, or every individual or group

hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery,

or renewed in this state that is required to cover perinatal community health worker services as

defined in subsections (a) and (b) of this section, shall report utilization and cost information related

to community health worker services to the office of the health insurance commissioner on or

LC004893/SUB A/2 - Page 4 of 7

before July 1, 2026 and each July 1 thereafter. The office of the health insurance commissioner

shall define the utilization and cost information required to be reported.

     (d) This section shall not apply to insurance coverage providing benefits for:

     (1) Hospital confinement indemnity;

     (2) Disability income;

     (3) Accident only;

     (4) Long-term care;

     (5) Limited benefit health;

     (6) Specified disease indemnity;

     (7) Sickness or bodily injury or death by accident or both; and

     (8) Other limited benefit policies.

     SECTION 4. Chapter 27-41 of the General Laws entitled "Health Maintenance

Organizations" is hereby amended by adding thereto the following section:

     27-41-100. Community health workers.

     (a) As used in this section, “community health worker” means a trained professional

providing services that are considered medically necessary for patients with one or more chronic

health, including behavioral health, conditions, patients who are at risk for a chronic health

condition, and/or who face barriers meeting their health or health-related social needs. Services that

can be provided by community health workers can include, but are not limited to:

     (1) Health and promotion coaching;

     (2) Health education and training;

     (3) Health system navigation and resource coordination services;

     (4) Care planning; and

     (5) Follow-up care recommendations.

     (b)(1) Every individual or group health insurance contract, or every individual or group

hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery,

or renewed in this state on or after January 1, 2025, shall provide coverage for the services of a

community health worker in accordance with each health insurer's respective principles and

mechanisms of reimbursement, credentialing, and contracting, if the services are within the

community health worker's area of professional competence as defined by the community health

worker certification standard developed and maintained by the Rhode Island certification board in

collaboration with the department of health, and are currently reimbursed when rendered by any

other healthcare provider.

     (2) No insurer or hospital or medical service corporation may require supervision,

LC004893/SUB A/2 - Page 5 of 7

signature, or referral by any other healthcare provider as a condition of reimbursement, except when

those requirements are also applicable to other categories of healthcare providers.

     (3) No insurer or hospital or medical service corporation or patient may be required to pay

for duplicate services actually rendered by both a community health worker and any other

healthcare provider.

     (c) Every individual or group health insurance contract, or every individual or group

hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery,

or renewed in this state that is required to cover perinatal community health worker services as

defined in subsections (a) and (b) of this section, shall report utilization and cost information related

to community health worker services to the office of the health insurance commissioner on or

before July 1, 2026 and each July 1 thereafter. The office of the health insurance commissioner

shall define the utilization and cost information required to be reported.

     (d) This section shall not apply to insurance coverage providing benefits for:

     (1) Hospital confinement indemnity;

     (2) Disability income;

     (3) Accident only;

     (4) Long-term care;

     (5) Limited benefit health;

     (6) Specified disease indemnity;

     (7) Sickness or bodily injury or death by accident or both; and

     (8) Other limited benefit policies.

     SECTION 5. Chapter 27-18.2 of the General Laws entitled "Medicare Supplement

Insurance Policies" is hereby amended by adding thereto the following section:

     27-18.2-12. Community health workers.

     (a) As used in this section. "community health worker" means a trained professional

providing services that are considered medically necessary for patients with one or more chronic

health, including behavioral health, conditions, patients who are at risk for a chronic health

condition, and/or who face barriers meeting their health or health-related social needs. Services that

can be provided by community health workers can include. but are not limited to:

     (1) Health and promotion coaching;

     (2) Health education and training;

     (3) Health system navigation and resource coordination services;

     (4) Care planning; and

     (5) Follow-up care recommendations.

LC004893/SUB A/2 - Page 6 of 7

     (b)(l) Every individual or group health insurance contract, or every individual or group

hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery,

or renewed in this state on or after January 1, 2025, shall provide coverage for the services of a

community health worker in accordance with each health insurer's respective principles and

mechanisms of reimbursement, credentialing, and contracting, if the services are within the

community health worker's area of professional competence as defined by the community health

worker certification standard developed and maintained by the Rhode Island certification board in

collaboration with the department of health, and are currently reimbursed when rendered by any

other healthcare provider.

     (2) No insurer or hospital or medical service corporation may require supervision,

signature, or referral by any other healthcare provider as a condition of reimbursement, except when

those requirements are also applicable to other categories of healthcare providers.

     (3) No insurer or hospital or medical service corporation or patient may be required to pay

for duplicate services actually rendered by both a community health worker and any other

healthcare provider.

     (c) Every individual or group health insurance contract, or every individual or group

hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery,

or renewed in this state that is required to cover community health worker services as defined in

subsections (a) and (b) of this section, shall report utilization and cost information related to

community health worker services to the office of the health insurance commissioner on or before

July 1, 2026 and each July 1 thereafter. The office of the health insurance commissioner shall define

the utilization and cost information required to be reported.

     (d) This section shall not apply to insurance coverage providing benefits for:

     (1) Hospital confinement indemnity;

     (2) Disability income;

     (3) Accident only;

     (4) Long-term care;

     (5) Limited benefit health;

     (6) Specified disease indemnity;

     (7) Sickness or bodily injury or death by accident or both; and

     (8) Other limited benefit policies.

     SECTION 6. This act shall take effect upon passage.

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LC004893/SUB A/2

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LC004893/SUB A/2 - Page 7 of 7

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

include, but not be limited to, health and promotion coaching, health education and training, health

system navigation and resource coordination services, care planning and follow-up care

recommendations. Coverage would not be provided for insurance coverage providing benefits for

hospital confinement indemnity, disability income, accident only, long-term care, Medicare

supplement, limited benefit health, specified disease indemnity, sickness or bodily injury or death

by accident, or both, and other limited benefit policies.

     This act would take effect upon passage.

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LC004893/SUB A/2

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