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 | |
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A N A C T | |
RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES | |
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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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EXPLANATION | |
BY THE LEGISLATIVE COUNCIL | |
OF | |
A N A C T | |
RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES | |
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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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