H5256 would require certain Rhode Island health insurers to reimburse services provided by physician assistants and certified nurse practitioners at the same rate as services provided by physicians, when the service is within the provider’s lawful scope of practice. The bill applies to accident and sickness policies, nonprofit hospital service corporations, and nonprofit medical service corporations, and it specifically covers primary care and mental health services, including prescribing or dispensing drugs when permitted by law.
The bill defines “independent practice” for physician assistants and nurse practitioners and requires equal reimbursement in those settings based on the amount paid to a physician in the area served. It also bars insurers from lowering physician reimbursement to offset the new parity requirement. The measure excludes certain federally qualified group practice HMOs and other insurers that employ providers and do not pay on a fee-for-service basis. If enacted, the law would take effect January 1, 2026.
Impact
The bill would amend three chapters of Rhode Island insurance law: the accident and sickness insurance policies chapter, the nonprofit hospital service corporations chapter, and the nonprofit medical service corporations chapter. It would create new statutory sections requiring payment parity for covered services performed by physician assistants and certified nurse practitioners, while preserving existing coverage rules and limiting insurer cost-shifting. The practical effect would be to expand reimbursement protections for advanced practice providers and potentially affect insurer payment policies, provider contracting, and claims processing for primary care and mental health services.
Sentiment
Based on the bill text and the absence of recorded committee testimony or votes in the provided materials, the measure appears to be framed positively as a provider-payment equity bill. Its title and structure suggest support for recognizing the role of nurse practitioners and physician assistants in delivering care and ensuring they are paid comparably when performing covered services. No contrary public sentiment is documented in the supplied record.
Contention
The main policy issue is reimbursement parity: supporters are likely to view the bill as correcting payment disparities for physician assistants and nurse practitioners, especially in independent practice, while opponents may be concerned about increased insurance costs and the impact on premium rates or provider payment structures. Another possible point of contention is the exclusion for certain HMOs and employer-based arrangements, which may be seen as limiting the bill’s reach. The prohibition on reducing physician reimbursement to comply with the mandate also suggests concern about avoiding cost shifting among provider types.