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H 8335Health Insurance

Insurance - Medicaid and Commercial Primary Care Rate Enhancement and Sustainability Act

This bill mandates that Medicaid and private insurers pay independent primary care doctors higher rates to match neighboring states.

Held for study
Population
Affected
65
Email Legislator
Introduced Mar 20, 2026Committee House Finance

Plain-English Summary

This legislation is designed to financially support independent primary care practices and nurse practitioners in Rhode Island. It mandates that the state Medicaid program and private commercial insurance companies increase the reimbursement rates paid to these providers. Specifically, it requires Medicaid to provide monthly supplemental payments for patients and accelerates rate increases. Furthermore, it requires commercial insurers to raise their primary care payment rates to match the higher averages found in neighboring states like Massachusetts and Connecticut by July 2027. The goal is to prevent the closure of small, independent medical offices.

For younger readers

Many family doctors who have their own small offices are having a hard time paying their bills because they don't get paid enough for their work. This new law tells health insurance companies and the government health program that they must pay these doctors more money for taking care of sick people. It wants to make sure doctors in Rhode Island get paid the same amount as doctors in nearby states. This helps make sure that your family doctor can keep their office open so you can visit them when you need to.

Who & Where It Applies

Impacted groups
Independent primary care physiciansNurse practitionersMedicaid recipientsCommercial insurance companiesMedicare Advantage plans
Impacted communities
All

Constitutional & Fiscal Check

The bill mandates that private commercial entities (insurers) pay specific rates tied to averages in other states. While states have broad authority to regulate the insurance industry, strict price-fixing mandates could potentially be challenged under the Contracts Clause or Due Process Clause if insurers argue the rates are arbitrary or confiscatory. However, similar rate-setting regulations in healthcare often survive judicial scrutiny.

Estimated cost
Amount unknown
Estimated revenue
None

Bill Analysis

Both viewpoints
For Progressives
  • Strengthens the social safety net by ensuring that Medicaid patients retain access to primary care, preventing a two-tiered system where low-income individuals cannot find a doctor.
  • Protects small, independent local practices from being bought out or crushed by large corporate hospital systems, promoting community-based care over corporate consolidation.
  • Addresses wage stagnation for care providers by mandating parity with neighboring states, ensuring that healthcare workers are compensated fairly for their essential labor.
  • Mandating higher reimbursement rates for commercial insurers will likely result in higher insurance premiums and deductibles for working-class families and individuals.
  • Reinforces the fee-for-service private insurance model rather than moving the state toward a universal, single-payer public healthcare system.
  • While it increases payments to providers, it does not strictly mandate that the increased revenue be used to improve patient outcomes or lower costs for the patients themselves.
For Conservatives
  • Supports small business owners (independent physicians) and helps them survive against market consolidation by large hospital conglomerates.
  • Utilizes federal matching funds to stabilize the local healthcare market without necessarily requiring an immediate state tax increase.
  • Encourages competition in the healthcare market by keeping independent options available, rather than forcing patients into large, bureaucratic hospital systems.
  • Represents significant government overreach by dictating price controls and interfering with private contracts between insurance companies and medical providers.
  • Artificial manipulation of market rates by the government distorts the free market and removes the ability of insurers to negotiate competitive pricing.
  • Expands the scope and cost of the Medicaid program, creating a long-term financial obligation that may eventually fall on state taxpayers.

Votes

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Full Bill Text

Changes to existing Rhode Island law · 41 additions

SECTION 1. Legislative findings. The general assembly finds that independent primary care practices face unsustainable overhead increases and reimbursement compression, resulting in closures and patient displacement. Commercial primary care rates in Rhode Island lag approximately twenty-nine percent (29%) behind neighboring states. State-directed payments under 42 C.F.R. § 438.6(c) provide a no-net- cost mechanism to stabilize these practices using existing Medicaid funds and federal matching dollars. Enhanced rates, supplements, and commercial parity are essential to prevent further closures and reduce system-wide costs.

SECTION 2. Title 27 of the General Laws entitled "INSURANCE" is hereby amended by adding thereto the following chapter: 27-18.10-1. Short title. This chapter shall be known and may be cited as the “Medicaid and Commercial Primary Care Rate Enhancement and Sustainability Act” 27-18.10-2. Patient-centered medical home expansion and enhanced per-member- per-month supplements.

(a) The executive office of health and human services (EOHHS) shall expand the patient- centered medical home (PCMH) program to all Medicaid-accepting independent primary care practices and nurse practitioners.

(b) Through state-directed payments under 42 C.F.R. § 438.6(c), EOHHS shall require managed care organizations (MCOs) to pay an enhanced per-member-per-month (PMPM) supplement of ten dollars ($10.00) to twenty dollars ($20.00) for each attributed Medicaid patient to eligible independent providers who enroll in PCMH or meet equivalent criteria. 27-18.10-3. Rate acceleration; Automatic per-member-per-month access payments and bonus.

(a) EOHHS shall accelerate the FY2026 primary care rate increase to one hundred percent (100%) of Medicare and add a temporary twenty-five percent (25%) bonus for independent (non- hospital-employed) practices.

(b) Through state-directed payments under 42 C.F.R. § 438.6(c), EOHHS shall require MCOs to pay an automatic access payment supplement of eight dollars ($8.00) to fifteen dollars ($15.00) PMPM for every attributed Medicaid patient in qualifying independent practices. 27-18.10-4. Commercial rate parity. The office of the health insurance commissioner shall require commercial insurers and Medicare Advantage plans to align primary care reimbursement rates with those in Massachusetts and Connecticut (approximately twenty-nine percent (29%) higher on average) through phased implementation: fifteen percent (15%) by January 1, 2027 and full alignment by July 1, 2027. 27-18.10-5. Eligibility and implementation.

(a) Eligibility is limited to independent primary care physicians and nurse practitioners who accept Medicaid and meet minimal quality and reporting requirements established by EOHHS.

(b) On and after January 1, 2027, EOHHS shall:

(1) Submit the necessary state-directed payment preprints to the centers for Medicare & Medicaid services;

(2) Update all MCO contracts to incorporate these payments;

(3) Build on the existing multi-payer PCMH program administered by the office of the health insurance commissioner (OHIC) in consultation with the Care Transformation Collaborative of Rhode Island (CTC-RI); and

(4) Issue annual reports on access, retention, and cost savings.

(c) The office of the health insurance commissioner shall amend regulations and insurer contracts to enforce commercial parity. 27-18.10-6. Enforcement. The office of the health insurance commissioner and EOHHS shall enforce this chapter under existing authority. Non-compliant contract provisions are void.

SECTION 3. This act shall take effect on January 1, 2027.