2026 -- H 8335

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LC006082

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2026

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A N   A C T

RELATING TO INSURANCE -- MEDICAID AND COMMERCIAL PRIMARY CARE RATE

ENHANCEMENT AND SUSTAINABILITY ACT

     Introduced By: Representatives Hopkins, Cruz, J. Brien, Casimiro, Cotter, Boylan,
Shanley, Phillips, Lima, and Place

     Date Introduced: March 20, 2026

     Referred To: House Finance

     It is enacted by the General Assembly as follows:

     SECTION 1. Legislative findings.

     The general assembly finds that independent primary care practices face unsustainable

overhead increases and reimbursement compression, resulting in closures and patient displacement.

Commercial primary care rates in Rhode Island lag approximately twenty-nine percent (29%)

behind neighboring states. State-directed payments under 42 C.F.R. § 438.6(c) provide a no-net-

cost mechanism to stabilize these practices using existing Medicaid funds and federal matching

dollars. Enhanced rates, supplements, and commercial parity are essential to prevent further

closures and reduce system-wide costs.

     SECTION 2. Title 27 of the General Laws entitled "INSURANCE" is hereby amended by

adding thereto the following chapter:

CHAPTER 18.10

MEDICAID AND COMMERCIAL PRIMARY CARE RATE ENHANCEMENT AND

SUSTAINABILITY ACT

     27-18.10-1. Short title.

     This chapter shall be known and may be cited as the “Medicaid and Commercial Primary

Care Rate Enhancement and Sustainability Act”

     27-18.10-2. Patient-centered medical home expansion and enhanced per-member-

per-month supplements.

     (a) The executive office of health and human services (EOHHS) shall expand the patient-

centered medical home (PCMH) program to all Medicaid-accepting independent primary care

practices and nurse practitioners.

     (b) Through state-directed payments under 42 C.F.R. § 438.6(c), EOHHS shall require

managed care organizations (MCOs) to pay an enhanced per-member-per-month (PMPM)

supplement of ten dollars ($10.00) to twenty dollars ($20.00) for each attributed Medicaid patient

to eligible independent providers who enroll in PCMH or meet equivalent criteria.

     27-18.10-3. Rate acceleration; Automatic per-member-per-month access payments

and bonus.

     (a) EOHHS shall accelerate the FY2026 primary care rate increase to one hundred percent

(100%) of Medicare and add a temporary twenty-five percent (25%) bonus for independent (non-

hospital-employed) practices.

     (b) Through state-directed payments under 42 C.F.R. § 438.6(c), EOHHS shall require

MCOs to pay an automatic access payment supplement of eight dollars ($8.00) to fifteen dollars

($15.00) PMPM for every attributed Medicaid patient in qualifying independent practices.

     27-18.10-4. Commercial rate parity.

     The office of the health insurance commissioner shall require commercial insurers and

Medicare Advantage plans to align primary care reimbursement rates with those in Massachusetts

and Connecticut (approximately twenty-nine percent (29%) higher on average) through phased

implementation: fifteen percent (15%) by January 1, 2027 and full alignment by July 1, 2027.

     27-18.10-5. Eligibility and implementation.

     (a) Eligibility is limited to independent primary care physicians and nurse practitioners

who accept Medicaid and meet minimal quality and reporting requirements established by EOHHS.

     (b) On and after January 1, 2027, EOHHS shall:

     (1) Submit the necessary state-directed payment preprints to the centers for Medicare &

Medicaid services;

     (2) Update all MCO contracts to incorporate these payments;

     (3) Build on the existing multi-payer PCMH program administered by the office of the

health insurance commissioner (OHIC) in consultation with the Care Transformation Collaborative

of Rhode Island (CTC-RI); and

     (4) Issue annual reports on access, retention, and cost savings.

     (c) The office of the health insurance commissioner shall amend regulations and insurer

contracts to enforce commercial parity.

     27-18.10-6. Enforcement.

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     The office of the health insurance commissioner and EOHHS shall enforce this chapter

under existing authority. Non-compliant contract provisions are void.

     SECTION 3. This act shall take effect on January 1, 2027.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE -- MEDICAID AND COMMERCIAL PRIMARY CARE RATE

ENHANCEMENT AND SUSTAINABILITY ACT

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     This act would enact the Medicaid and commercial primary care rate enhancement and

sustainability act, expanding the patient-centered medical home program to all Medicaid-accepting

independent primary care practices and nurse practitioners. This act would increase rates paid by

commercial insurers and Medicare Advantage plans to align with the reimbursement rates in

Massachusetts and Connecticut starting with a fifteen percent (15%) increase on January 1,

2027and full alignment by July 1, 2027.

     This act would take effect on January 1, 2027.

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