Requires insurance coverage for all community health workers' services to include health and promotion coaching, health education and training, health system navigation and resource coordination services, care planning and follow-up care recommendations.
H6117 would require most Rhode Island health insurance contracts and policies to cover medically necessary services provided by community health workers, beginning with policies delivered, issued, or renewed on or after January 1, 2026. The bill defines community health workers as trained professionals serving patients with chronic health or behavioral health conditions, people at risk of developing such conditions, and people facing barriers related to health-related social needs. Covered services include health coaching, health education, care navigation, resource coordination, care planning, and follow-up care recommendations.
The mandate applies across several insurance categories, including accident and sickness insurance policies, nonprofit hospital service corporations, nonprofit medical service corporations, health maintenance organizations, and Medicare supplement insurance policies. It also requires insurers to follow their existing reimbursement, credentialing, and contracting mechanisms, prohibits requiring supervision, signatures, or referrals unless those requirements apply equally to other provider types, and bars payment for duplicate services when both a community health worker and another provider render the same service. Insurers subject to the mandate must also report utilization and cost data to the Office of the Health Insurance Commissioner starting July 1, 2027, with the office defining the reporting details.
The bill would amend multiple chapters of Rhode Island insurance law by adding a new coverage requirement for community health worker services in accident and sickness policies, nonprofit hospital service corporations, nonprofit medical service corporations, health maintenance organizations, and Medicare supplement policies. It would create a statutory definition of community health worker and establish a new insurance benefit standard tied to services already reimbursed when provided by other healthcare providers. The bill excludes several limited-benefit lines of coverage, such as hospital confinement indemnity, disability income, accident-only, long-term care, limited benefit health, specified disease indemnity, and other limited benefit policies. It would take effect January 1, 2026, and would also add a reporting obligation for insurers to submit utilization and cost information to the health insurance commissioner.
Based on the bill text and available context, the measure appears generally supportive of expanding access to community-based care and integrating community health workers into insurance reimbursement systems. The bill was introduced by a group of House representatives and referred to the House Health & Human Services Committee, suggesting policy interest in preventive care, chronic disease management, and health equity. No committee transcript or vote record is available in the provided materials, so there is no documented recorded opposition or formal vote sentiment to assess.
The main policy questions raised by the bill are likely to concern insurance costs, reimbursement administration, and the scope of covered services. The bill requires coverage only when community health worker services are within the worker’s certified competence and are already reimbursed when performed by another healthcare provider, which may limit disputes over scope but still leaves implementation details to insurers and the health insurance commissioner. Another potential point of contention is the prohibition on requiring supervision, signatures, or referrals unless those requirements apply equally to other provider categories, which could be viewed by insurers as limiting utilization controls. The bill also excludes Medicare supplement policies from the explanatory summary only insofar as the bill text includes them in Section 5; the broader exclusion language applies to limited-benefit products, so any debate would likely focus on how the mandate interacts with existing benefit structures and administrative rules.