2025 -- H 5861

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LC001900

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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

     Introduced By: Representatives Stewart, Fogarty, McGaw, Cruz, and Casimiro

     Date Introduced: February 28, 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. Licensed certified lactation counselor.

     (a) As used in this section, “licensed certified lactation counselor” means a trained

professional who holds a licensure and certification by the department of health in accordance with

chapter 13.8 of title 23. Licensed certified lactation counselors provide services in assessment,

evaluation, problem identification, treatment, education, and consultation to provide lactation care

and services to childbearing families, and infant children from birth to twelve (12) months old

within the scope of practice pursuant to the provisions of § 23-13.8-9.

     (b) 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, 2026, shall provide coverage for the services of

lactation counselors in accordance with each health insurers' respective principles and mechanisms

of reimbursement, credentialing, and contracting, if the services are within the lactation counselors'

area of professional competence pursuant to the provisions of chapter 13.8 of title 23 ("lactation

counselor practice act of 2024"), and are currently reimbursed when rendered by any other health

care provider. No insurer or hospital or medical service corporation may require supervision,

signature, or referral by any other health care provider as a condition of reimbursement, except

when those requirements are also applicable to other categories of health care providers. No insurer

or hospital or medical service corporation or patient may be required to pay for duplicate services

actually rendered by both a licensed certified lactation counselor and any other health care 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 licensed certified lactation counselor services

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

licensed certified lactation counselor 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) Medicare supplement;

     (6) Limited benefit health;

     (7) Specified disease indemnity;

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

     (9) 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. Licensed certified lactation counselor.

     (a) As used in this section, “licensed certified lactation counselor” means a trained

professional who holds a licensure and certification by the department of health in accordance with

chapter 13.8 of title 23. Licensed certified lactation counselors provide services in assessment,

evaluation, problem identification, treatment, education, and consultation to provide lactation care

and services to childbearing families, and infant children from birth to twelve (12) months old

within the scope of practice pursuant to the provisions of § 23-13.8-9.

     (b) 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, 2026, shall provide coverage for the services of

lactation counselors in accordance with each health insurers' respective principles and mechanisms

of reimbursement, credentialing, and contracting, if the services are within the lactation counselors'

area of professional competence pursuant to the provisions of chapter 13.8 of title 23 ("lactation

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counselor practice act of 2024"), and are currently reimbursed when rendered by any other health

care provider. No insurer or hospital or medical service corporation may require supervision,

signature, or referral by any other health care provider as a condition of reimbursement, except

when those requirements are also applicable to other categories of health care providers. No insurer

or hospital or medical service corporation or patient may be required to pay for duplicate services

actually rendered by both a licensed certified lactation counselor and any other health care 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 licensed certified lactation counselor services

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

licensed certified lactation counselor 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) Medicare supplement;

     (6) Limited benefit health;

     (7) Specified disease indemnity;

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

     (9) 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. Licensed certified lactation counselor.

     (a) As used in this section, “licensed certified lactation counselor” means a trained

professional who holds a licensure and certification by the department of health in accordance with

chapter 13.8 of title 23. Licensed certified lactation counselors provide services in assessment,

evaluation, problem identification, treatment, education, and consultation to provide lactation care

and services to childbearing families, and infant children from birth to twelve (12) months old

within the scope of practice pursuant to the provisions of § 23-13.8-9.

     (b) 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,

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or renewed in this state on or after January 1, 2026, shall provide coverage for the services of

lactation counselors in accordance with each health insurers' respective principles and mechanisms

of reimbursement, credentialing, and contracting, if the services are within the lactation counselors'

area of professional competence pursuant to the provisions of chapter 13.8 of title 23 ("lactation

counselor practice act of 2024"), and are currently reimbursed when rendered by any other health

care provider. No insurer or hospital or medical service corporation may require supervision,

signature, or referral by any other health care provider as a condition of reimbursement, except

when those requirements are also applicable to other categories of health care providers. No insurer

or hospital or medical service corporation or patient may be required to pay for duplicate services

actually rendered by both a licensed certified lactation counselor and any other health care 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 licensed certified lactation counselor services

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

licensed certified lactation counselor 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) Medicare supplement;

     (6) Limited benefit health;

     (7) Specified disease indemnity;

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

     (9) 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. Licensed certified lactation counselor.

     (a) As used in this section, “licensed certified lactation counselor” means a trained

professional who holds a licensure and certification by the department of health in accordance with

chapter 13.8 of title 23. Licensed certified lactation counselors provide services in assessment,

evaluation, problem identification, treatment, education, and consultation to provide lactation care

LC001900 - Page 4 of 6

and services to childbearing families, and infant children from birth to twelve (12) months old

within the scope of practice pursuant to the provisions of § 23-13.8-9.

     (b) 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, 2026, shall provide coverage for the services of

lactation counselors in accordance with each health insurers' respective principles and mechanisms

of reimbursement, credentialing, and contracting, if the services are within the lactation counselors'

area of professional competence pursuant to the provisions of chapter 13.8 of title 23 ("lactation

counselor practice act of 2024"), and are currently reimbursed when rendered by any other health

care provider. No insurer or hospital or medical service corporation may require supervision,

signature, or referral by any other health care provider as a condition of reimbursement, except

when those requirements are also applicable to other categories of health care providers. No insurer

or hospital or medical service corporation or patient may be required to pay for duplicate services

actually rendered by both a licensed certified lactation counselor and any other health care 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 licensed certified lactation counselor services

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

licensed certified lactation counselor 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) Medicare supplement;

     (6) Limited benefit health;

     (7) Specified disease indemnity;

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

     (9) Other limited benefit policies.

     SECTION 5. This act shall take effect on January 1, 2026.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

***

     This act would require health insurance policies to cover licensed certified lactation

counselor services for childbearing families. It would also prohibit requiring supervision or

duplicate payments for services and mandates annual reporting.

     This act would take effect on January 1, 2026.

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