The bill amends the General Laws to include coverage for services provided by community health workers in individual or group health insurance contracts, as well as hospital or medical expense insurance policies, plans, or group policies. Community health workers are defined as trained professionals who assist patients with chronic health conditions, those at risk for chronic conditions, or those facing barriers to health or health-related social needs. Their services encompass health promotion, education, system navigation, care planning, and follow-up care recommendations. The bill stipulates that from January 1, 2025, insurers must cover these services within the scope of the community health worker's professional competence, as defined by the Rhode Island certification board in collaboration with the department of health. Insurers are prohibited from requiring supervision, signature, or referral by another healthcare provider for reimbursement unless it is a common requirement for all healthcare providers. Additionally, the bill prevents charges for duplicate services provided by a community health worker and another healthcare provider.
The legislation also includes a reporting requirement for insurers covering community health worker services to submit utilization and cost information to the office of the health insurance commissioner by July 1, 2026, and annually thereafter. The commissioner's office will determine the specifics of the information to be reported. However, the bill exempts certain types of insurance coverage from these provisions, including hospital confinement indemnity, disability income, accident only, long-term care, limited benefit health, specified disease indemnity, sickness or bodily injury or death by accident, and other limited benefit policies. The act will take effect upon passage.