2025 -- H 6373

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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 Cotter, Donovan, Speakman, Boylan, McGaw, Casimiro,
Fogarty, Kislak, Potter, and Place

     Date Introduced: May 28, 2025

     Referred To: House Finance

     (Attorney General)

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. Payment parity for primary care services.

     (a) Definitions. As used in this section, unless the context clearly requires otherwise:

     (1) “Primary care billing and payment codes” means the primary care payment codes to be

used by health insurers to meet the primary care expenditure requirements established by the office

of the health insurance commissioner pursuant to §§ 42-14-5, 42-14-17 and 42-14.5-1, et seq.

     (2) “Primary care provider” means a provider within the practice types of family medicine,

geriatrics, internal medicine, and pediatrics, as described by the primary care provider taxonomy

codes as defined in this section, and providers with the following professional credentials:

physicians, certified nurse practitioners, and physician assistants; except that a specialty medical

provider including, but not limited to, an obstetrics/gynecology or behavioral health provider, may

be considered a primary care provider if they meet any criteria set forth, or are otherwise designated

as such, pursuant to guidance or regulations issued by the executive office of health and human

services pursuant to § 42-7.2-11.

     (3) “Primary care services” means services described by the primary care billing and

payment codes, as defined in this section, for:

     (i) Care management;

     (ii) Care planning;

     (iii) Consultation services;

     (iv) Health risk assessments, screening and health behavior counseling;

     (v) Home visits;

     (vi) Hospice and home health services;

     (vii) Immunization administrations; and

     (viii) Office visits and preventive medicine visits.

     (4) “Primary care provider taxonomy codes” means the primary care specialty provider

taxonomy codes to be used by health insurers to meet the primary care expenditure requirements

established by the office of the health insurance commissioner pursuant to §§ 42-14-5, 42-14-17,

and 42-14.5-1, et seq.

     (b) Achieving parity with Medicare rates for primary care services. The executive office of

health and human services shall pursue a Medicaid state plan amendment, waiver submission, or

any other necessary change in regulation or guidance, and shall allocate sufficient state general

revenue, to increase Medicaid payment rates for primary care services furnished by primary care

providers to equal no less than one hundred percent (100%) of Medicare rates. This increase shall

be effective beginning July 1, 2025.

     (c) Implementation. In implementing this section, the executive office of health and human

services shall ensure that Medicaid managed care organizations shall pay no less than the rates that

would be paid for that care under subsection (b) of this section for these service types and shall

pursue any necessary amendment to, or any execution of, contracts with Medicaid managed care

organizations to promptly effectuate this provision. With respect to primary care services furnished

by primary care providers participating in the Medicaid accountable entity program, the executive

office of health and human services shall make any such payment adjustments as may be necessary

to ensure such entities receive an equivalent benefit, taking into account the financial methodology

of such program. With respect to primary care services furnished by primary care providers at

community health centers, the executive office of health and human services shall adjust the

alternative payment methodology under which community health centers are reimbursed as may

be necessary to ensure such centers receive an equivalent increase in reimbursement.

     (d) Sunset. Unless extended by the general assembly, the provisions of this section shall

sunset and expire on June 30, 2027.

     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

***

     This act would require the executive office of health and human services to increase

Medicaid payment rates for primary care services furnished by primary care providers to be

commensurate with Medicare rates, and would require the executive office of health and human

services to ensure equivalent rate adjustments are made available to providers participating in

Medicaid managed care organizations, Medicaid accountable entities, and community health

centers.

     This act would take effect upon passage.

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