2025 -- H 6254

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LC002712

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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 HUMAN SERVICES -- MEDICAL ASSISTANCE

     Introduced By: Representatives Shallcross Smith, Voas, Casimiro, Solomon, Fellela,
Cotter, Perez, Biah, McNamara, and Caldwell

     Date Introduced: April 23, 2025

     Referred To: House Finance

     It is enacted by the General Assembly as follows:

     SECTION 1. Chapter 40-8 of the General Laws entitled "Medical Assistance" is hereby

amended by adding thereto the following section:

     40-8-33. Minimum obesity coverage standards in Medicaid.

     (a) As used in this section:

     (1) "Comprehensive coverage for treatment of obesity" means coverage for prevention and

wellness nutrition counseling, intensive behavioral therapy, bariatric surgery, and FDA-approved

anti-obesity medication.

     (2) "FDA-approved anti-obesity medication" means any medication approved by the U.S.

Food and Drug Administration for chronic weight management in patients with obesity.

     (b) On and after July 1, 2025, the Medicaid program shall include comprehensive coverage

for treatment of obesity, to include coverage for obesity prevention and wellness, nutrition

counseling, intensive behavioral therapy, bariatric surgery, and FDA-approved anti-obesity

medication.

     (c) Coverage criteria for FDA-approved anti-obesity medications provided under this

section shall not be more restrictive than the FDA-approved indications for those medicines.

     (d) Coverage under this section shall be consistent with coverage for any other illness,

condition, or disorder for purposes of determining deductibles, lifetime dollar limits, copayment

and coinsurance factors, and benefit year maximum for deductibles and copayment and coinsurance

factors.

     (e) Nothing shall preclude the Medicaid program’s use of utilization management to

determine the medical necessity for treatment of obesity under this section; provided that, all

appropriateness and medical necessity determinations are made in the same manner as those

determinations are made for the treatment of any other illness, condition, or disorder covered by

the state Medicaid plan.

     (f) The Medicaid program shall provide notice to its enrollees regarding the coverage

required by this section. The notice shall be in writing and prominently positioned in any literature

or correspondence sent to enrollees and shall be transmitted to enrollees within calendar years 2025

and 2026 when annual information is made available to enrollees, and in any other mailing to

enrollees, but in no case later than their renewal date.

     (g) The Medicaid program shall provide notice to healthcare providers and prescribers in

the state regarding the coverage required in this section. The notice shall be in writing and shall be

transmitted to healthcare providers and prescribers within both calendar years 2025 and 2026 when

annual information or Medicaid plan change information is made available to healthcare providers

and prescribers, but in no case shall the initial notice be provided later than October 31, 2025.

     (h) The executive office of health and human services is directed and authorized to apply

for and obtain any necessary waiver(s), waiver amendment(s) and/or state plan amendments from

the Secretary of the United States Department of Health and Human Services including, but not

limited to, a section 1115 demonstration waiver.

     SECTION 2. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO HUMAN SERVICES -- MEDICAL ASSISTANCE

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     This act would authorize the executive office of health and human services (EOHHS) to

establish a program, on or after July 1, 2025, to establish comprehensive coverage for treatment of

obesity, including prescription treatments for certain individuals where there is a clinical need. This

program would seek to receive expanded authority to provide FDA-approved anti-obesity

medication when medically appropriate. The executive office would seek a Medicaid section 1115

demonstration waiver request and renewal to a seek waiver of the compliance provisions of 42

U.S.C. section 1396d(a) ("definitions"), as set forth in subsection (b) of this resolution.

     This act would take effect upon passage.

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