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3/5/2024 Senate leaders unveil Rhode Island HEALTH Initiative
STATE HOUSE – Today, Senate leaders unveiled a 25-bill legislative package aimed at improving health care access and affordability in Rhode Island.
 
To address the challenges facing the state’s health care system, the Rhode Island HEALTH Initiative (Holistic Enhancement and Access Legislation for Total Health) focuses on four key pillars: consumer protection, provider availability and care quality, cost containment, and health system financial stability.
 
The initiative was announced by Senate President Dominick J. Ruggerio; Senate Majority Leader Ryan W. Pearson; Senate Health & Human Services Committee Chairman Joshua Miller; Senate Environment & Agriculture Committee Chairwoman Alana M. DiMario, who works as a licensed mental health counselor in private practice; and Senate Health & Human Services Committee Secretary Pamela J. Lauria, who works as a primary care nurse practitioner.
 
“Few issues are as important as health care, and right now, our health care system is in critical condition. Health care absolutely must be accessible and affordable for all Rhode Islanders. But for too many people in our state, care is too expensive or too difficult to get. And we know that many health care providers are feeling enormous strain due to many factors. Like providers and consumers, our community hospitals, including Fatima in my district, are facing difficult circumstances. I want to recognize the outstanding work of my colleagues in the Senate in the development of this package of bills, and thank our many other partners, including many vital stakeholders, for working collaboratively with us on these issues,” said President Ruggerio (D-Dist. 4, North Providence, Providence).
 
“We are very fortunate in the Senate to have a such a knowledgeable and dedicated membership committed to addressing the challenges facing our state. When we approached the development of this package of bills, we wanted to take a holistic approach to addressing the many intertwined factors that impact the health care system. These bills – the Rhode Island HEALTH Initiative – are taking important steps that, taken together, will have a real impact at improving the health of our health care system, containing costs for providers and consumers, and improving access to care,” said Leader Pearson (D-Dist. 19, Cumberland, Lincoln).
 
 
 
CONSUMER PROTECTION
 
“As a licensed mental health counselor, I am closely connected to the struggles of patients as they navigate so many facets of their lives. But for too many, simply trying to navigate our health care system only adds to their struggle. It’s more than just the cost – it is the obstacles they too often face in terms transparency and predictability. That is why we have focused on consumer protections as a pillar of this initiative,” said Chairwoman DiMario (D-Dist. 36, North Kingstown, Narragansett, New Shoreham).
 
  1. Hospital determination of Medicare & Medicaid eligibility for uninsured patients (Sponsored by Sen. Lauria, 2024-S 2714): This legislation would require all hospitals to screen uninsured patients for Medicaid, Medicare, and other financial assistance programs. It would require hospitals to hold all invoices/claims until 30 days after discharge for the purposes of application review and determination. It additionally establishes a complaint process at EOHHS for complaints and violations. The Attorney General is empowered to bring legal action against the hospital and can permit a corrective action plan in lieu of legal action.
  2. State purchase of medical debt through ARPA funding (Sponsored by Sen. Mark McKenney, 2024-S 2712): This new bill would use federal American Rescue Plan Act funds to purchase medical debt for pennies on the dollar, and then eliminate that debt for eligible Rhode Islanders. To be eligible, residents would need to have outstanding medical debt that equals 5% or more of their annual income and more than $600 of debt or have a household that is no more than 400% of the federal poverty line. The elimination of debt in this manner has been done in Connecticut, New York City, and Cook County, Illinois.
  3. Prohibition on medical debt reporting to credit bureaus (Sponsored by Sen. Melissa Murray, 2024-S 2709): This bill would prohibit debt collectors from reporting all medical debt to credit bureaus. It also sets rules for communication with consumers, false and misleading representation by debt collectors, and a prohibition against collections during insurance appeals.
  4. Medical debt interest rate cap (Sponsored by Sen. John Burke, 2024-S 2710): This bill would cap the interest rate on new medical debt at the interest rate equal to the weekly average 1-week constant maturity Treasury yield, but not less than 1.5 percent annum nor more than 4 percent annum, as published by the Board of Governors for the Federal Reserve System. The interest rate would also be extended to judgments on medical debt.  New debt is defined as debt incurred after the date of enactment.
  5. Prohibition on medical debt attachments (Sponsored by Sen. Jacob Bissaillon, 2024-S 2711): This bill would prohibit the attachment of a lien to an individual’s home because of medical debt.
  6. Surprise billing protections (Sponsored by Sen. DiMario, 2024-S 2715): This legislation would include ambulance service as part of the emergency provisions of the insurance statutes. Providers would have to accept the patient’s co-payment or deductible as payment for service, and the bill also continues to allow them to seek payment from worker compensation and other third-party payers. This expands many of the balance billing protections Rhode Island currently has in place, and it would put the state in line with many of its neighbors in New England.
 
PROVIDER AVAILABILITY & CARE QUALITY
 
“Over the years in my work as a primary care nurse practitioner, it has become increasingly clear the many ways in which our health care system is struggling. A shortage of providers across all facets of the health system is an especially urgent concern, and while that starts with primary care, it extends to nurses, specialists, counselors, and beyond. One of the pillars of the initiative we are announcing today seeks to address the issue of provider availability, because to truly ensure everyone has access to quality care, we must have enough providers to meet our needs,” said Senator Lauria (D-Dist. 32, Barrington, Bristol, East Providence).
 
  1. Enhanced Curriculum & Clinical Training (Sponsored by Sen. Lauria, 2024-S 2716): This bill that would provide $2.7 million to primary care practices to serve as enhanced interdisciplinary clinical training sites. It would recruit 30 advanced primary care training sites with one or more preceptors, increasing training slots by 50% for nurse practitioners, physician assistant students, and physician residents. The funds would also be used to develop a site curriculum, quarterly learning collaborative sessions, data collection, and project management. These sites are needed to train the next generation of providers, and since students often decide to work where they train, increasing training can improve access to care.  
  2. Primary Care Scholarship Program (Sponsored by Sen. Lauria, 2024-S 2717): This legislation would fund a 4-year scholarship program for primary care physicians, nurse practitioners, and physician’s assistants. The students would either remain in Rhode Island after medical school or return to Rhode Island after residency training in Family Medicine, Pediatrics, or General Internal Medicine to practice primary care for 8 years. The goals would be to encourage medical students to practice in these fields due to the reduction or elimination of their student debt.
  3. Medicaid reimbursement for mental health intern work (Sponsored by Sen. DiMario, 2024-S 2713): This bill would allow for Medicaid reimbursement for services provided by an intern to help offset the supervising facility’s costs in having interns. Currently, intern spots in the state are reduced because facilities cannot afford to take many on; this would open that pipeline so prospective mental health providers could intern in Rhode Island and remain in-state.
  4. Uniform Telehealth Act (Sponsored by Sen. Lauria, 2024-S 2179): This bill would allow for registered out-of-state health care practitioners to provide telehealth services to patients, as long as the work is consistent with the provider’s scope and standards.  
  5. Social Work Interstate Licensure Compact (Sponsored by Sen. DiMario, 2024-S 2184): This legislation would make Rhode Island one of the founding states in the compact, able to participate in rulemaking to establish the interstate licensure credential for social workers. It will provide increased access to mental health support for Rhode Island residents and increased work options for Rhode Island social workers.
  6. Counseling Compact (Sponsored by Sen. Matthew LaMountain, 2024-S 2183): This legislation would adopt an existing compact, providing increased access to mental health support for state residents and increased work options for Rhode Island social workers.
  7. Audiology Compact (Sponsored by Senate President Pro Tempore Hanna Gallo, 2024-S 2173): This legislation would adopt the Audiology and Speech-Language Pathology Interstate Compact and establish a commission to administer the provisions in the compact between the states. This act would take effect on the date that the 10th member state enacts the compact into law.
  8. Physician Assistant Compact (Sponsored by Sen. Bridget Valverde, 2024-S 2178): This legislation would adopt the Physician Assistant Licensure Compact. The compact will be activated once the 7th state passes compact language into law.
  9. Occupational Therapy Compact (Sponsored by Sen. Miller, 2024-S 2623): This legislation would adopt the Occupational Therapy Licensure Compact, which has been adopted by 27 states. This compact will become operational in the second half of 2024.
  10. NCLEX pending exemption (Sponsored by Senate Majority Whip Valarie Lawson, 2024-S 2083): This legislation would allow for a nurse to be exempt from certain licensing requirements to practice before taking and receiving results from the NCLEX, the licensing examine developed by the National Council of State Boards of Nursing.
  11. Physical therapy licensing (Sponsored by Sen. Matthew LaMountain, 2024-S 2718): This act would streamline physical therapy licensing.
 
COST CONTAINMENT
 
“Health care is an extremely complex policy area. The details can be daunting, and consensus can be difficult to reach. I am grateful to Senate leadership, the members of the Health & Human Services Committee, the staff members and stakeholders who support and inform our work, and my colleagues for their efforts to advance this initiative. We have made cost containment a priority because it’s no secret that inflation has placed financial strain on Rhode Islanders, and increasing medical costs are not sustainable for our state’s working families,” said Chairman Miller (D-Dist. 28, Cranston, Providence).
 
  1. Creation of a drug affordability commission (Sponsored by Sen. DiMario, 2024-S 2719): This legislation would create a drug affordability commission to receive and review manufacturers’ submissions. The commission would determine whether the cost of a drug under review is affordable. If the commission finds that the cost in Rhode Island is not affordable to state health care systems and state residents, it is authorized to establish a cost or payment rate for the drug to which all state programs, local governments, state-licensed commercial health plans (including state marketplace plans), state-licensed pharmacies, wholesalers and distributors must abide. These “covered entities” would be prohibited from paying more for the drugs than the commission established rate, with enforcement by the Attorney General.
  2. Pharma Coupons (Sponsored by Sen. Robert Britto, 2024-S 2720): This bill would ensure that cost savings from pharmaceutical coupons are provided to the consumer, not the insurer, pharmacy benefit (PBM) manager, or some other party.
  3. Separate NPI for off-site procedures (Sponsored by Sen. Miller, 2024-S 2721): This legislation would require a separate NPI (National Provider Identifier) for off-site procedures instead of using a hospital’s NPI. This would prevent hospital systems from charging the more expensive hospitals rate for services rendered at offsite locations, such as primary care offices. Unique, separate, and distinct codes would have to be obtained for the main campus, each off-campus location, and each provider type when the hospital delivers medical care, services, or goods at either the hospital’s main campus or an off-campus location.
  4. Price transparency (Sponsored by Senate Minority Leader Jessica de la Cruz, 2024-S 2078): This legislation would codify Centers for Medicare & Medicaid Services rules that require hospitals to publish pricing information in two formats: a consumer-friendly list of 300 “shoppable services,” and a comprehensive machine-readable file for all items and services. Placing this sunshine requirement into statute will help people understand and reduce costs.
 
HEALTH SYSTEM FINANCIAL STABILITY
 
“Ensuring the overall financial stability of the health care system in our state is absolutely critical. I am so grateful to the many senators who have been committed to developing effective solutions to these complex challenges,” said Leader Pearson.
 
  1. OHIC dual mandate (Sponsored by Sen. Sosnowski, 2024-S 2722): This legislation would shift the Health Insurance Commissioner’s mandate to a dual mandate focused on both premiums and provider rates.
  2. Dental medical loss ratio (Sponsored by Sen. Gallo, 2024-S 2724): This legislation would require carriers offering dental coverage to annually submit information that includes current and projected medical loss ratio (MLR) for claims. The MLR would be 85% for determining whether insureds are due a refund or premium credit. The percentage is the same for health MLR and within the same range of neighboring states.
  3. Adding primary care to rate review (Sponsored by Leader Pearson, 2024-S 2723): This legislation would require OHIC to conduct a rate review of primary care rates in the state.
  4. Low-income drug program (Sponsored by Sen. Valverde, 2024-S 2725): This legislation protects Rhode Island’s most vulnerable residents’ access to health care by protecting Rhode Island 340B providers from discriminatory practices used by pharmacy benefit managers, insurance companies, and drug manufacturers.
Debra Hurwitz, MBA, BSN, RN, executive director of the Care Transformation Collaborative of RI, said: “As Rhode Island continues to face a mounting primary care workforce shortage, resulting in difficulty for patients accessing primary care, our Collaborative has been working to pilot and advance programs that focus on recruiting, training, and retaining primary care providers in Rhode Island. Our work has included launching a Primary Care Workforce Task Force – bringing physicians, nurses, higher education institutions, and experienced experts to the table – to develop real next steps solutions to this workforce crisis.

“The Rhode Island HEALTH Initiative includes key efforts identified by our Task Force to bolster the workforce including: scholarships for primary care trainees – future physicians, nurse practitioners, and physician assistants – and enhancing the curriculum and increasing the capacity for clinical training sites so that more primary care providers can be trained here in Rhode Island. We are grateful to Senate President Ruggerio, our Task Force member Senator Lauria, and the dedicated Senators prioritizing the critical needs of primary care this session.”



For more information, contact:
Greg Pare, Director of Communications for the Senate
State House Room 112
Providence, RI 02903
(401) 276-5558


Attachment(s):
RI HEALTH Initiative update.pdf