2024 -- S 2606 SUBSTITUTE A AS AMENDED

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LC004893/SUB A/2

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2024

____________

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:

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. 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, 2025, 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

 

1

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

2

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

3

other healthcare provider.

4

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

5

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

6

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

7

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

8

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

9

healthcare provider.

10

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

11

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

12

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

13

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

14

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

15

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

16

the utilization and cost information required to be reported.

17

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

18

     (1) Hospital confinement indemnity;

19

     (2) Disability income;

20

     (3) Accident only;

21

     (4) Long-term care;

22

     (5) Limited benefit health;

23

     (6) Specified disease indemnity;

24

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

25

     (8) Other limited benefit policies.

26

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

27

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

28

     27-19-87. Community health workers.

29

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

30

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

31

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

32

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

33

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

34

     (1) Health and promotion coaching;

 

LC004893/SUB A/2 - Page 2 of 8

1

     (2) Health education and training;

2

     (3) Health system navigation and resource coordination services;

3

     (4) Care planning; and

4

     (5) Follow-up care recommendations.

5

     (b)(1) 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 on or after January 1, 2025, shall provide coverage for the services of a

8

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

9

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

10

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

11

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

12

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

13

other healthcare provider.

14

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

15

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

16

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

17

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

18

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

19

healthcare provider.

20

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

21

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

22

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

23

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

24

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

25

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

26

the utilization and cost information required to be reported.

27

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

28

     (1) Hospital confinement indemnity;

29

     (2) Disability income;

30

     (3) Accident only;

31

     (4) Long-term care;

32

     (5) Limited benefit health;

33

     (6) Specified disease indemnity;

34

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

 

LC004893/SUB A/2 - Page 3 of 8

1

     (8) Other limited benefit policies.

2

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

3

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

4

     27-20-83. Community health workers.

5

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

6

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

7

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

8

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

9

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

10

     (1) Health and promotion coaching;

11

     (2) Health education and training;

12

     (3) Health system navigation and resource coordination services;

13

     (4) Care planning; and

14

     (5) Follow-up care recommendations.

15

     (b)(1) 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 on or after January 1, 2025, shall provide coverage for the services of a

18

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

19

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

20

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

21

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

22

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

23

other healthcare provider.

24

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

25

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

26

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

27

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

28

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

29

healthcare provider.

30

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

31

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

32

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

33

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

34

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

 

LC004893/SUB A/2 - Page 4 of 8

1

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

2

the utilization and cost information required to be reported.

3

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

4

     (1) Hospital confinement indemnity;

5

     (2) Disability income;

6

     (3) Accident only;

7

     (4) Long-term care;

8

     (5) Limited benefit health;

9

     (6) Specified disease indemnity;

10

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

11

     (8) Other limited benefit policies.

12

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

13

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

14

     27-41-100. Community health workers.

15

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

16

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

17

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

18

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

19

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

20

     (1) Health and promotion coaching;

21

     (2) Health education and training;

22

     (3) Health system navigation and resource coordination services;

23

     (4) Care planning; and

24

     (5) Follow-up care recommendations.

25

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

26

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

27

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

28

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

29

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

30

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

31

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

32

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

33

other healthcare provider.

34

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

 

LC004893/SUB A/2 - Page 5 of 8

1

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

2

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

3

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

4

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

5

healthcare provider.

6

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

7

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

8

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

9

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

10

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

11

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

12

the utilization and cost information required to be reported.

13

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

14

     (1) Hospital confinement indemnity;

15

     (2) Disability income;

16

     (3) Accident only;

17

     (4) Long-term care;

18

     (5) Limited benefit health;

19

     (6) Specified disease indemnity;

20

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

21

     (8) Other limited benefit policies.

22

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

23

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

24

     27-18.2-12. Community health workers.

25

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

26

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

27

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

28

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

29

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

30

     (1) Health and promotion coaching;

31

     (2) Health education and training;

32

     (3) Health system navigation and resource coordination services;

33

     (4) Care planning; and

34

     (5) Follow-up care recommendations.

 

LC004893/SUB A/2 - Page 6 of 8

1

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

2

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

3

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

4

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

5

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

6

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

7

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

8

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

9

other healthcare provider.

10

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

11

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

12

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

13

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

14

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

15

healthcare provider.

16

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

17

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

18

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

19

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

20

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

21

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

22

the utilization and cost information required to be reported.

23

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

24

     (1) Hospital confinement indemnity;

25

     (2) Disability income;

26

     (3) Accident only;

27

     (4) Long-term care;

28

     (5) Limited benefit health;

29

     (6) Specified disease indemnity;

30

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

31

     (8) Other limited benefit policies.

32

     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 8

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 community health workers’ services to

2

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

3

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

4

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

5

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

6

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

7

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

8

     This act would take effect upon passage.

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LC004893/SUB A/2

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LC004893/SUB A/2 - Page 8 of 8