RI 2026 S2806: Insurance - Accident and Sickness Insurance Policies - Equal Pay for Healthcare Providers

Plain-English Summary

This legislation mandates that health insurance companies and the state Medicaid program reimburse licensed Nurse Practitioners and Physician Assistants at the same rate as physicians when they perform the same services. This requirement applies specifically to practitioners in independent practice who bill under their own names. The bill explicitly prohibits insurance companies from lowering the reimbursement rates for physicians to comply with this new rule. Exceptions are made for certain Health Maintenance Organizations (HMOs) that employ staff directly rather than paying on a fee-for-service basis.

For younger readers

When you go to the doctor's office, you might see a helper called a Nurse Practitioner or a Physician Assistant instead of the main doctor. They can do many of the same things, like give check-ups or prescribe medicine. Right now, insurance companies often pay them less money than doctors for doing the same job. This new law says that insurance companies must pay these helpers the exact same amount of money as the doctors when they do the same work. It makes sure everyone gets paid fair money for the job they do.

Who & Where It Applies

Impacted groups

Nurse PractitionersPhysician AssistantsHealth Insurance CompaniesMedicaid RecipientsPhysicians

Impacted communities

All

Constitutional & Fiscal Check

None Likely

Estimated cost

Amount unknown

Estimated revenue

None

Bill Analysis

Both viewpoints

For Progressives

Promotes labor equity by ensuring that healthcare professionals performing the exact same services receive the same compensation, regardless of their specific title.
Likely expands access to healthcare in underserved and rural communities where Nurse Practitioners often serve as the primary source of medical care.
Strengthens the social safety net by mandating these reimbursement standards for Medicaid, ensuring that low-income patients have access to a broader range of financially viable providers.
May lead to increased health insurance premiums for working families if insurance companies pass the cost of higher provider reimbursements onto consumers.
Increases state spending on Medicaid, which diverts taxpayer funds toward higher provider payments rather than expanding other social services or benefits.
Could incentivize a profit-driven model of healthcare delivery among mid-level practitioners, shifting focus away from the service-oriented model often associated with nursing.

For Conservatives

Encourages the growth of independent small businesses by allowing Nurse Practitioners and Physician Assistants to operate their own practices with greater financial viability.
Promotes market competition in the healthcare sector by reducing the dominance of large hospital systems, potentially offering patients more provider choices.
Protects existing physician revenue streams by explicitly prohibiting insurance companies from lowering physician reimbursement rates to fund these mandates.
Represents significant government interference in the free market by dictating the specific price terms of private contracts between insurance companies and providers.
Will likely result in higher taxes or state budget deficits due to the government-mandated increase in Medicaid reimbursement rates for mid-level practitioners.
Disregards the significant differences in education costs and training time between physicians and other practitioners by artificially equalizing the market value of their services.

Votes

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Full Bill Text

Changes to existing Rhode Island law · 97 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. Equal pay for healthcare providers.

(a) Whenever any policy of health insurance provides for reimbursement for any service which is within the lawful scope of practice of a duly licensed and certified nurse practitioner, as defined in § 5-34-3, including prescribing or dispensing drugs, a primary care or mental health service, provided by a licensed physician, the insured under the policy is entitled to reimbursement for such service, whether it is performed by a physician licensed by the board of medical licensure and discipline or by a duly licensed nurse practitioner, if provided by a licensed physician assistant, as defined in chapter 54 of title 5 or a certified nurse practitioner, or other licensed healthcare professionals, as defined in § 27-18-1.1, if the service is within the lawful scope of practice of the physician assistant or nurse practitioner.

(b) The reimbursement of a service described in subsection (a) of this section that is provided by a licensed physician assistant or a certified nurse practitioner who is in an independent practice shall be in the same amount as the reimbursement paid under the policy to a licensed physician performing the service in the area served.

(c) As used in this section, “independent practice” means the provision of healthcare services to patients in a setting in which the licensed physician assistant or the certified nurse practitioner bills insurers for services identified by diagnosis and procedure codes using the physician assistant’s or nurse practitioner’s own name and national provider identifier.

(d) This section does not apply to group practice health maintenance organizations that are federally qualified pursuant to Title XIII of the Health Maintenance Organization Act, or other insurers that employ physicians, licensed physician assistants or certified nurse practitioners to provide primary care or mental health services and do not compensate such practitioners on a fee for-service basis.

(e) An insurer may not reduce the reimbursement paid to a licensed physician in order to comply with this section.

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. Equal pay for healthcare providers.

(a) Whenever any policy of health insurance provides for reimbursement for any service which is within the lawful scope of practice of a duly licensed and certified nurse practitioner, as defined in § 5-34-3, including prescribing or dispensing drugs, a primary care or mental health service, provided by a licensed physician, the insured under the policy is entitled to reimbursement for such service, whether it is performed by a physician licensed by the board of medical licensure and discipline or by a duly licensed nurse practitioner, if provided by a licensed physician assistant, as defined in chapter 54 of title 5 or a certified nurse practitioner, or other licensed healthcare professionals, as defined in § 27-18-1.1, if the service is within the lawful scope of practice of the physician assistant or nurse practitioner.

(b) The reimbursement of a service described in subsection (a) of this section that is provided by a licensed physician assistant or a certified nurse practitioner who is in an independent practice shall be in the same amount as the reimbursement paid under the policy to a licensed physician performing the service in the area served.

(c) As used in this section, “independent practice” means the provision of healthcare services to patients in a setting in which the licensed physician assistant or the certified nurse practitioner bills insurers for services identified by diagnosis and procedure codes using the physician assistant’s or nurse practitioner’s own name and national provider identifier.

(d) This section does not apply to group practice health maintenance organizations that are federally qualified pursuant to Title XIII of the Health Maintenance Organization Act, or other insurers that employ physicians, licensed physician assistants or certified nurse practitioners to provide primary care or mental health services and do not compensate such practitioners on a fee for-service basis.

(e) An insurer may not reduce the reimbursement paid to a licensed physician in order to comply with this section.

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. Equal pay for healthcare providers.

(a) Whenever any policy of health insurance provides for reimbursement for any service which is within the lawful scope of practice of a duly licensed and certified nurse practitioner, as defined in § 5-34-3, including prescribing or dispensing drugs, a primary care or mental health service, provided by a licensed physician, the insured under the policy is entitled to reimbursement for such service, whether it is performed by a physician licensed by the board of medical licensure and discipline or by a duly licensed nurse practitioner, if provided by a licensed physician assistant, as defined in chapter 54 of title 5 or a certified nurse practitioner, or other licensed healthcare professionals, as defined in § 27-18-1.1, if the service is within the lawful scope of practice of the physician assistant or nurse practitioner.

(b) The reimbursement of a service described in subsection (a) of this section that is provided by a licensed physician assistant or a certified nurse practitioner who is in an independent practice shall be in the same amount as the reimbursement paid under the policy to a licensed physician performing the service in the area served.

(c) As used in this section, “independent practice” means the provision of healthcare services to patients in a setting in which the licensed physician assistant or the certified nurse practitioner bills insurers for services identified by diagnosis and procedure codes using the physician assistant’s or nurse practitioner’s own name and national provider identifier.

(d) This section does not apply to group practice health maintenance organizations that are federally qualified pursuant to Title XIII of the Health Maintenance Organization Act, or other insurers that employ physicians, licensed physician assistants or certified nurse practitioners to provide primary care or mental health services and do not compensate such practitioners on a fee for-service basis.

(e) An insurer may not reduce the reimbursement paid to a licensed physician in order to comply with this section.

SECTION 4. Chapter 40-8 of the General Laws entitled "Medical Assistance" is hereby amended by adding thereto the following section: 40-8-33. Equal pay for healthcare providers.

(a) Beginning January 1, 2027, the executive office of health and human services (EOHHS) shall provide for reimbursement for any service which is within the lawful scope of practice of a duly licensed and certified nurse practitioner, as defined in § 5-34-3, including prescribing or dispensing drugs, a primary care or mental health service, provided by a licensed physician, the insured under the policy is entitled to reimbursement for such service, whether it is performed by a physician licensed by the board of medical licensure and discipline or by a duly licensed nurse practitioner, if provided by a licensed physician assistant, as defined in chapter 54 of title 5 or a certified nurse practitioner, or other licensed healthcare professionals, as defined in § 27-18-1.1, if the service is within the lawful scope of practice of the physician assistant or nurse practitioner.

(b) The reimbursement of a service described in subsection (a) of this section that is provided by a licensed physician assistant or a certified nurse practitioner who is in an independent practice shall be in the same amount as the reimbursement paid under the policy to a licensed physician performing the service in the area served.

(c) As used in this section, “independent practice” means the provision of healthcare services to patients in a setting in which the licensed physician assistant or the certified nurse practitioner bills insurers for services identified by diagnosis and procedure codes using the physician assistant’s or nurse practitioner’s own name and national provider identifier.

(d) The secretary of the EOHHS shall apply to the United States department of health and human services for any amendment to the state Medicaid plan or for any Medicaid waiver as necessary to implement this section. The secretary of the EOHHS shall submit the Medicaid state plan amendment on or before October 1, 2026.

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