2025 -- H 5256

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LC000780

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2025

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A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES--

EQUAL PAY FOR HEALTHCARE PROVIDERS

     Introduced By: Representatives Casimiro, Noret, Read, McEntee, Spears, Shanley, and
Morales

     Date Introduced: January 31, 2025

     Referred To: House 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. Equal pay for healthcare providers.

     (a) Whenever any policy of health insurance provides for reimbursement for any service

which is within the lawful scope of practice of a duly licensed and certified nurse practitioner, as

defined in § 5-34-3, including prescribing or dispensing drugs, a primary care or mental health

service, provided by a licensed physician, the insured under the policy is entitled to reimbursement

for such service, whether it is performed by a physician licensed by the board of medical licensure

and discipline or by a duly licensed nurse practitioner, if provided by a licensed physician assistant,

as defined in chapter 54 of title 5 or a certified nurse practitioner, or other licensed healthcare

professionals, as defined in § 27-18-1.1, if the service is within the lawful scope of practice of the

physician assistant or nurse practitioner.

     (b) The reimbursement of a service described in subsection (a) of this section that is

provided by a licensed physician assistant or a certified nurse practitioner who is in an independent

practice shall be in the same amount as the reimbursement paid under the policy to a licensed

physician performing the service in the area served.

     (c) As used in this section, “independent practice” means the provision of healthcare

services to patients in a setting in which the licensed physician assistant or the certified nurse

practitioner bills insurers for services identified by diagnosis and procedure codes using the

physician assistant’s or nurse practitioner’s own name and national provider identifier.

     (d) This section does not apply to group practice health maintenance organizations that are

federally qualified pursuant to Title XIII of the Health Maintenance Organization Act, or other

insurers that employ physicians, licensed physician assistants or certified nurse practitioners to

provide primary care or mental health services and do not compensate such practitioners on a fee-

for-service basis.

     (e) An insurer may not reduce the reimbursement paid to a licensed physician in order to

comply with this section.

     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. Equal pay for healthcare providers.

     (a) Whenever any policy of health insurance provides for reimbursement for any service

which is within the lawful scope of practice of a duly licensed and certified nurse practitioner, as

defined in § 5-34-3, including prescribing or dispensing drugs, a primary care or mental health

service, provided by a licensed physician, the insured under the policy is entitled to reimbursement

for such service, whether it is performed by a physician licensed by the board of medical licensure

and discipline or by a duly licensed nurse practitioner, if provided by a licensed physician assistant,

as defined in chapter 54 of title 5 or a certified nurse practitioner, or other licensed healthcare

professionals, as defined in § 27-18-1.1, if the service is within the lawful scope of practice of the

physician assistant or nurse practitioner.

     (b) The reimbursement of a service described in subsection (a) of this section that is

provided by a licensed physician assistant or a certified nurse practitioner who is in an independent

practice shall be in the same amount as the reimbursement paid under the policy to a licensed

physician performing the service in the area served.

     (c) As used in this section, “independent practice” means the provision of healthcare

services to patients in a setting in which the licensed physician assistant or the certified nurse

practitioner bills insurers for services identified by diagnosis and procedure codes using the

physician assistant’s or nurse practitioner’s own name and national provider identifier.

     (d) This section does not apply to group practice health maintenance organizations that are

federally qualified pursuant to Title XIII of the Health Maintenance Organization Act, or other

insurers that employ physicians, licensed physician assistants or certified nurse practitioners to

provide primary care or mental health services and do not compensate such practitioners on a fee-

for-service basis.

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     (e) An insurer may not reduce the reimbursement paid to a licensed physician in order to

comply with this section.

     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. Equal pay for healthcare providers.

     (a) Whenever any policy of health insurance provides for reimbursement for any service

     which is within the lawful scope of practice of a duly licensed and certified nurse

practitioner, as defined in § 5-34-3, including prescribing or dispensing drugs, a primary care or

mental health service, provided by a licensed physician, the insured under the policy is entitled to

reimbursement for such service, whether it is performed by a physician licensed by the board of

medical licensure and discipline or by a duly licensed nurse practitioner, if provided by a licensed

physician assistant, as defined in chapter 54 of title 5 or a certified nurse practitioner, or other

licensed healthcare professionals, as defined in § 27-18-1.1, if the service is within the lawful scope

of practice of the physician assistant or nurse practitioner.

     (b) The reimbursement of a service described in subsection (a) of this section that is

provided by a licensed physician assistant or a certified nurse practitioner who is in an independent

practice shall be in the same amount as the reimbursement paid under the policy to a licensed

physician performing the service in the area served.

     (c) As used in this section, “independent practice” means the provision of healthcare

services to patients in a setting in which the licensed physician assistant or the certified nurse

practitioner bills insurers for services identified by diagnosis and procedure codes using the

physician assistant’s or nurse practitioner’s own name and national provider identifier.

     (d) This section does not apply to group practice health maintenance organizations that are

federally qualified pursuant to Title XIII of the Health Maintenance Organization Act, or other

insurers that employ physicians, licensed physician assistants or certified nurse practitioners to

provide primary care or mental health services and do not compensate such practitioners on a fee-

for-service basis.

     (e) An insurer may not reduce the reimbursement paid to a licensed physician in order to

comply with this section.

     SECTION 4. This act shall take effect on January 1, 2026.

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LC000780

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES--

EQUAL PAY FOR HEALTHCARE PROVIDERS

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     This act would provide for equal pay for healthcare providers.

     This act would take effect on January 1, 2026.

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LC000780

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