SECTION 1. Title 42 of the General Laws entitled "STATE AFFAIRS AND GOVERNMENT" is hereby amended by adding thereto the following chapter: 42-7.5-1. Short title and purpose.
(a) This chapter shall be known and may be cited as the “Rhode Island Protect Our Healthcare Act of 2026.”
(b) The purpose of this chapter is to create a state program to provide healthcare services to individuals who cannot obtain affordable health insurance coverage and who lack the means to pay for their own healthcare services. 42-7.5-2. Definitions. As used in this chapter:
(1) “Advisory committee” means the uninsured care advisory committee established pursuant to § 42-7.5-4.
(2) “Board” means the uninsured care board established pursuant to § 42-7.5-4.
(3) “Community health centers” shall have the meaning provided in § 40-8-26.
(4) “Individual” means any person who is a resident of the State of Rhode Island.
(5) “Participating hospital” shall have the meaning provided in § 40-8.3-2.
(6) “Secretary” means the secretary of the executive office of health and human services. 42-7.5-3. Program fund.
(a) There shall be established a state general fund appropriation to fund the activities described in this chapter, and to be allocated by the board pursuant to the procedure described in § 42-7.5-5.
(b) For the fiscal year beginning July 1, 2026 and ending June 30, 2027, there shall be appropriated from the general fund fifty-three million two hundred thousand dollars ($53,200,000) for the administration of the program established pursuant to this chapter.
(c) For any fiscal year beginning on or after July 1, 2027, there shall be appropriated from the general fund one hundred nine million six hundred thousand dollars ($109,600,000) for the administration of the program established pursuant to this chapter. 42-7.5-4. Uninsured care board and advisory committee.
(a) There shall be established a seven (7) member Rhode Island uninsured care board, which shall include the following members:
(1) The secretary of the executive office of health and human services, who shall serve as chair of the board;
(2) The commissioner of the office of the health insurance commissioner;
(3) The director of the department of health;
(4) The Medicaid director;
(5) One person to be appointed by the governor with the advice and consent of the senate;
(6) One person to be appointed by the president of the senate; and
(7) One person to be appointed by the speaker of the house of representatives.
(b) There shall be established the uninsured care board advisory committee, which shall include at least the following nine (9) members, to be appointed by the secretary of the executive office of health and human services in consultation with the other members of the board:
(1) A representative of community health centers;
(2) A representative of participating hospitals;
(3) A representative of a free clinic;
(4) A representative of a primary care provider not employed by a community health center or a practice owned by a hospital system;
(5) A behavioral healthcare provider;
(6) Two (2) additional healthcare providers, each of whom practices in a different specialty than the other;
(7) A representative of a healthcare advocacy organization;
(8) A consumer of healthcare who is not a representative or an employee of any provider of healthcare or an insurance carrier; and
(9) Any other persons appointed by the secretary to create a board with a comprehensive composition to include a range and diversity of skills, backgrounds, and stakeholder perspectives.
(c) The board shall undertake a review of existing programs that serve uninsured individuals including, but not limited to, identifying:
(1) Programs that provide services to uninsured individuals;
(2) The scope of services provided by the aforesaid programs;
(3) Whether the programs provide services to uninsured individuals only;
(4) The qualifications associated with those programs used to condition participation;
(5) The methodology the programs use to provide funding to participating providers, if applicable; and
(6) The size of the programs including, but not limited to:
(i) The number of individuals served;
(ii) The number of services provided;
(iii) The cost of the program; and
(iv) Any other metrics fundamental to explaining the capacity of the program.
(d) The board shall, on or before February 1, 2027, provide a report to the general assembly detailing the information provided for in subsection (c) of this section.
(e) The board shall determine the appropriate allocation of funds to be distributed under § 42-7.5-5, the design and implementation of the program created by § 42-7.5-6, the process by which the program shall be evaluated, and all reporting on the design, efficacy, and impact of the program.
(1) The board shall make such determinations and exercise its authority with consideration to the recommendations made by the advisory committee.
(2) The board shall provide appropriate opportunities for stakeholders and the public to consult in its deliberations, pursuant to the specifications of § 42-7.5-7. 42-7.5-5. Allocation of program fund.
(a) The board may allocate funds appropriated under this chapter to advance programs that will traceably provide expanded access to care for uninsured individuals utilizing appropriated funding. The board may:
(1) Provide additional distributions of funds to participating hospitals in accordance with § 40-8.3-3;
(2) Provide additional distributions of funds to community health centers in accordance with § 40-8-26;
(3) Provide additional distributions of funds to the Rhode Island Free Clinic, Clínica Esperanza, or any other clinic that provides healthcare services free of charge to individuals;
(4) Provide funding for the uninsured health access program established pursuant to § 42- 7.5-6; and
(5) Provide funding for the operation of the board and the advisory committee.
(b) If any funds allocated to any of the activities provided pursuant to subsection (a) of this section remain unexhausted at the end of a state fiscal year, they shall not be returned to the general fund and the board may reallocate them to the same activity or another activity for a subsequent fiscal year. 42-7.5-6. Uninsured health access program.
(a) The Rhode Island uninsured health access program (“program”) is hereby established:
(1) To support individuals who are uninsured;
(2) To support healthcare providers to provide access to a spectrum of healthcare services not otherwise available to individuals without regard to ability to pay; and
(3) That provides payment directly to participating healthcare providers, on behalf of individuals, in correspondence to specific qualifying services rendered by those providers and/or contingent upon the providers’ adherence to access standards established by the board.
(b) The program shall serve as the payer of last resort for any services rendered to uninsured individuals, up to the amount allocated by the board under § 42-7.5-5(a)(3).
(c) The board may establish:
(1) The qualifications for a provider to participate in the program;
(2) The services covered by the program;
(3) The qualifications for individuals to participate in the program including, but not limited to, income or asset limits, and/or the process by which participating providers may set guidelines for patient participation; provided that, such guidelines shall be reviewed and approved by the board;
(4) The requirements related to the expanded care to be offered by participating providers to uninsured patients in exchange for program funding;
(5) The screening to be completed by providers for forms of health insurance coverage that may be available to individuals supported by the program;
(6) The process and methodology by which funding is provided to providers under the program;
(7) The process by which providers may confirm the continued availability of funding in advance of providing services under this program;
(8) Any sliding scale or other cost sharing associated with particular services covered by the program;
(9) Any requirements related to prerequisite authorizations or other guidelines necessary for specific services to be covered by the program; and
(10) Any reporting or data submission requirements for participating providers.
(d) In making its determinations under subsection (c) of this section, the board shall prioritize consideration of:
(1) The recommendations of the advisory committee;
(2) Aligning the program with other programs that provide care to uninsured individuals including, but not limited to, the Breast and Cervical Cancer Treatment Program, Mobile Response and Stabilization Services, Emergency Medicaid, hospital uncompensated care or charity care programs, sliding scale services provided at community health centers, and services provided by free clinics;
(3) Aligning the program with other statewide initiatives relating to healthcare delivery system transformation including, but not limited to, the Rural Health Transformation Program;
(4) Maintaining as broad a variety of types of healthcare services and providers as possible including, but not limited to:
(i) Primary care services including, but not limited to, services available from providers other than free clinics or community health centers;
(ii) Inpatient and outpatient services;
(iii) Mental health and substance use disorder services;
(iv) Specialty care services;
(v) Preventive services;
(vi) Imaging and lab services;
(vii) Dental services; and
(viii) Prescription drugs.
(e) The board shall ensure that participating providers who receive funding from the program provide bona fide and traceable access to healthcare services for qualified uninsured patients including, but not limited to, the ability to make appointments and schedule non-emergency or post-acute services, and ensure that funds from the program are not used solely to cover participating providers’ existing losses related to existing uncompensated care already provided.
(f) The board may engage in procurement or other processes to identify and contract with participating providers, and may utilize methodologies to maximize the availability of federal matching funds or other funds to help support the program. 42-7.5-7. Rules and regulations.
(a) The secretary of the executive office of health and human services, in consultation with the board, may promulgate rules and regulations as necessary to carry out and implement the purposes of this chapter.
(b) Chapter 35 of title 42, (“administrative procedures”) shall apply for any rules or regulations established or issued by the board pursuant to this chapter, except for the first implementation year of the program established under this chapter.
(c) For the first implementation year, the board shall provide opportunities for stakeholders and the public to provide input. This shall include, but is not limited to:
(1) A duly noticed public meeting with advice from the advisory committee established by § 42-7.5-4;
(2) A thirty (30) day public comment period; and
(3) Presentation by the board to the public of accompanying explanatory documentation outlining any proposed regulatory adoption, any significant changes thereto, and the rationale for those decisions. 42-7.5-8. Construction. This chapter shall not be construed to create an entitlement, medical assistance, or a public assistance program of any kind. 42-7.5-9. Severability. The provisions of this chapter are severable, and if any provision hereof shall be held invalid in any circumstances, any invalidity shall not affect any other provisions or circumstances.
SECTION 2. This act shall take effect upon passage.
