RI 2026 S2383: Insurance - Accident and Sickness Insurance Policies

Plain-English Summary

This legislation mandates that individual and group health insurance policies in Rhode Island provide coverage for services rendered by licensed certified lactation counselors. This requirement applies to policies issued or renewed on or after January 1, 2027. The bill ensures coverage for lactation care for childbearing families and infants up to 12 months old. It prohibits insurers from requiring referrals or supervision by other providers unless generally applicable, and prevents payment for duplicate services. Additionally, insurers must report utilization and cost data to the Office of the Health Insurance Commissioner annually starting in July 2027.

For younger readers

This new rule helps moms and their new babies. sometimes, moms need help learning how to feed their babies with milk from their own bodies, which is called breastfeeding. There are special helpers called lactation counselors who teach them how to do this. This law says that health insurance companies must pay for these helpers so families do not have to pay all the money themselves. It makes sure moms can get this help easily for the baby's first year without needing a special note from a doctor first.

Who & Where It Applies

Impacted groups

Pregnant women and new mothersInfants (0-12 months)Licensed Certified Lactation CounselorsHealth Insurance CompaniesOffice of the Health Insurance Commissioner

Impacted communities

All

Constitutional & Fiscal Check

None Likely

Estimated cost

None

Estimated revenue

None

Bill Analysis

Both viewpoints

For Progressives

Expand access to essential postpartum healthcare services for families, particularly benefiting low-income mothers who might otherwise be unable to afford lactation support.
Promotes public health and infant welfare by removing financial and administrative barriers to breastfeeding, which is linked to better long-term health outcomes.
Empowers women and childbearing parents by validating lactation counseling as a covered professional service, ensuring they receive specialized support during the critical first year of an infant's life.
Relies on the private insurance market structure, failing to assist those who are uninsured or underinsured, rather than establishing a universal guarantee of care.
The coverage mandate is limited to infants up to twelve months old, which may not support mothers who choose to or need to breastfeed beyond the first year.
Insurance companies may pass the associated costs of this mandate onto consumers in the form of higher premiums or deductibles, potentially impacting the collective affordability of healthcare.

For Conservatives

Supports the traditional family unit and the health of infants by ensuring that mothers have the necessary support to care for their children.
Reduces bureaucratic red tape for patients by prohibiting insurers from requiring doctor referrals or supervision for these specific services.
Includes fiscal safeguards that prevent payment for duplicate services, ensuring that insurance companies are not billed twice for the same care.
Imposes government mandates on private businesses by forcing insurance companies to cover specific services, interfering with free market principles and contract freedom.
Increases the regulatory burden on businesses by requiring annual reporting of utilization and cost data to a government commissioner.
Likely leads to increased insurance premiums for all policyholders to subsidize the cost of these specific services, regardless of whether the policyholder will use them.

Votes

Loading votes...

Full Bill Text

Changes to existing Rhode Island law · 144 additions

SECTION 1. Chapter 27-18 of the General Laws entitled "Accident and Sickness Insurance Policies" is hereby amended by adding thereto the following section: 27-18-96. Licensed certified lactation counselor.

(a) As used in this section, “licensed certified lactation counselor” means a trained professional who holds a licensure and certification by the department of health in accordance with chapter 13.8 of title 23. Licensed certified lactation counselors provide services in assessment, evaluation, problem identification, treatment, education, and consultation to provide lactation care and services to childbearing families, and infant children from birth to twelve (12) months old within the scope of practice pursuant to the provisions of § 23-13.8-9.

(b) Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state on or after January 1, 2027, shall provide coverage for the services of lactation counselors in accordance with each health insurers' respective principles and mechanisms of reimbursement, credentialing, and contracting, if the services are within the lactation counselors' area of professional competence pursuant to the provisions of chapter 13.8 of title 23 ("lactation counselor practice act of 2024"), and are currently reimbursed when rendered by any other health care provider. No insurer or hospital or medical service corporation may require supervision, signature, or referral by any other health care provider as a condition of reimbursement, except when those requirements are also applicable to other categories of health care providers. No insurer or hospital or medical service corporation or patient may be required to pay for duplicate services actually rendered by both a licensed certified lactation counselor and any other health care provider.

(c) Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state that is required to cover licensed certified lactation counselor services defined in subsection (a) of this section, shall report utilization and cost information related to licensed certified lactation counselor 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 shall define the utilization and cost information required to be reported.

(d) This section shall not apply to insurance coverage providing benefits for:

(1) Hospital confinement indemnity;

(2) Disability income;

(3) Accident only;

(4) Long-term care;

(5) Medicare supplement;

(6) Limited benefit health;

(7) Specified disease indemnity;

(8) Sickness or bodily injury or death by accident or both; and

(9) Other limited benefit policies.

SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service Corporations" is hereby amended by adding thereto the following section: 27-19-88. Licensed certified lactation counselor.

(a) As used in this section, “licensed certified lactation counselor” means a trained professional who holds a licensure and certification by the department of health in accordance with chapter 13.8 of title 23. Licensed certified lactation counselors provide services in assessment, evaluation, problem identification, treatment, education, and consultation to provide lactation care and services to childbearing families, and infant children from birth to twelve (12) months old within the scope of practice pursuant to the provisions of § 23-13.8-9.

(b) Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state on or after January 1, 2027, shall provide coverage for the services of lactation counselors in accordance with each health insurers' respective principles and mechanisms of reimbursement, credentialing, and contracting, if the services are within the lactation counselors' area of professional competence pursuant to the provisions of chapter 13.8 of title 23 ("lactation counselor practice act of 2024"), and are currently reimbursed when rendered by any other health care provider. No insurer or hospital or medical service corporation may require supervision, signature, or referral by any other health care provider as a condition of reimbursement, except when those requirements are also applicable to other categories of health care providers. No insurer or hospital or medical service corporation or patient may be required to pay for duplicate services actually rendered by both a licensed certified lactation counselor and any other health care provider.

(c) Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state that is required to cover licensed certified lactation counselor services defined in subsection (a) of this section, shall report utilization and cost information related to licensed certified lactation counselor 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 shall define the utilization and cost information required to be reported.

(d) This section shall not apply to insurance coverage providing benefits for:

(1) Hospital confinement indemnity;

(2) Disability income;

(3) Accident only;

(4) Long-term care;

(5) Medicare supplement;

(6) Limited benefit health;

(7) Specified disease indemnity;

(8) Sickness or bodily injury or death by accident or both; and

(9) Other limited benefit policies.

SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service Corporations" is hereby amended by adding thereto the following section: 27-20-84. Licensed certified lactation counselor.

(a) As used in this section, “licensed certified lactation counselor” means a trained professional who holds a licensure and certification by the department of health in accordance with chapter 13.8 of title 23. Licensed certified lactation counselors provide services in assessment, evaluation, problem identification, treatment, education, and consultation to provide lactation care and services to childbearing families, and infant children from birth to twelve (12) months old within the scope of practice pursuant to the provisions of § 23-13.8-9.

(b) Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state on or after January 1, 2027, shall provide coverage for the services of lactation counselors in accordance with each health insurers' respective principles and mechanisms of reimbursement, credentialing, and contracting, if the services are within the lactation counselors' area of professional competence pursuant to the provisions of chapter 13.8 of title 23 ("lactation counselor practice act of 2024"), and are currently reimbursed when rendered by any other health care provider. No insurer or hospital or medical service corporation may require supervision, signature, or referral by any other health care provider as a condition of reimbursement, except when those requirements are also applicable to other categories of health care providers. No insurer or hospital or medical service corporation or patient may be required to pay for duplicate services actually rendered by both a licensed certified lactation counselor and any other health care provider.

(c) Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state that is required to cover licensed certified lactation counselor services defined in subsection (a) of this section, shall report utilization and cost information related to licensed certified lactation counselor 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 shall define the utilization and cost information required to be reported.

(d) This section shall not apply to insurance coverage providing benefits for:

(1) Hospital confinement indemnity;

(2) Disability income;

(3) Accident only;

(4) Long-term care;

(5) Medicare supplement;

(6) Limited benefit health;

(7) Specified disease indemnity;

(8) Sickness or bodily injury or death by accident or both; and

(9) Other limited benefit policies.

SECTION 4. Chapter 27-41 of the General Laws entitled "Health Maintenance Organizations" is hereby amended by adding thereto the following section: 27-41-101. Licensed certified lactation counselor.

(a) As used in this section, “licensed certified lactation counselor” means a trained professional who holds a licensure and certification by the department of health in accordance with chapter 13.8 of title 23. Licensed certified lactation counselors provide services in assessment, evaluation, problem identification, treatment, education, and consultation to provide lactation care and services to childbearing families, and infant children from birth to twelve (12) months old within the scope of practice pursuant to the provisions of § 23-13.8-9.

(b) Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state on or after January 1, 2027, shall provide coverage for the services of lactation counselors in accordance with each health insurers' respective principles and mechanisms of reimbursement, credentialing, and contracting, if the services are within the lactation counselors' area of professional competence pursuant to the provisions of chapter 13.8 of title 23 ("lactation counselor practice act of 2024"), and are currently reimbursed when rendered by any other health care provider. No insurer or hospital or medical service corporation may require supervision, signature, or referral by any other health care provider as a condition of reimbursement, except when those requirements are also applicable to other categories of health care providers. No insurer or hospital or medical service corporation or patient may be required to pay for duplicate services actually rendered by both a licensed certified lactation counselor and any other health care provider.

(c) Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state that is required to cover licensed certified lactation counselor services defined in subsection (a) of this section, shall report utilization and cost information related to licensed certified lactation counselor 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 shall define the utilization and cost information required to be reported.

(d) This section shall not apply to insurance coverage providing benefits for:

(1) Hospital confinement indemnity;

(2) Disability income;

(3) Accident only;

(4) Long-term care;

(5) Medicare supplement;

(6) Limited benefit health;

(7) Specified disease indemnity;

(8) Sickness or bodily injury or death by accident or both; and

(9) Other limited benefit policies.

SECTION 5. This act shall take effect on January 1, 2027.