This bill amends various chapters of the General Laws to establish provisions for community health workers (CHWs) in health insurance coverage. It defines a CHW as a trained professional who provides services that are considered medically necessary for patients with one or more chronic health conditions, including behavioral health, and for those who are at risk for a chronic health condition or face barriers in meeting their health or health-related social needs.

Starting January 1, 2026, all individual or group health insurance contracts and hospital or medical expense insurance policies delivered, issued for delivery, or renewed in the state must provide coverage for services provided by CHWs. These services include, but are not limited to, health and promotion coaching, health education and training, health system navigation and resource coordination services, care planning, and follow-up care recommendations.

The bill prohibits insurers or hospital or medical service corporations from requiring supervision, signature, or referral by any other healthcare provider as a condition of reimbursement for CHW services, except when those requirements are also applicable to other categories of healthcare providers. Additionally, it states that no insurer, hospital or medical service corporation, or patient may be required to pay for duplicate services rendered by both a CHW and any other healthcare provider.

Furthermore, every health insurance contract that is required to cover CHW services must report utilization and cost information related to these services to the office of the health insurance commissioner on or before July 1, 2027, and each July 1 thereafter. The office of the health insurance commissioner will define the specific utilization and cost information that must be reported.

However, the provisions of this act do not apply to insurance coverage providing benefits for hospital confinement indemnity, disability income, accident only, long-term care, limited benefit health, specified disease indemnity, sickness or bodily injury or death by accident, or other limited benefit policies. The provisions of this act are set to take effect on January 1, 2026.