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 face barriers in meeting their health or health-related social needs. Services provided by CHWs 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.

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 the services of a CHW. This coverage must be in accordance with each health insurer's respective principles and mechanisms of reimbursement, credentialing, and contracting, provided the services are within the CHW's area of professional competence as defined by the community health worker certification standard developed by the Rhode Island certification board in collaboration with the department of health, and are currently reimbursed when rendered by any other healthcare provider.

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.

Every individual or group 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.

Certain types of insurance coverage, 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, are exempt from these requirements. The provisions of this act are set to take effect on January 1, 2026.