AN ACT RELATING TO HEALTH AND SAFETY -- EQUITABLE ACCESS PRIMARY CARE PRACTICES ACT (Allows primary care practices to offer optional fees for non-covered services while requiring equal medical care for all patients and protecting access to medically necessary services regardless of ability to pay.)

H8325

2026 -- H 8325
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LC006083
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STATE OF RHODE ISLAND
IN GENERAL ASSEMBLY
JANUARY SESSION, A.D. 2026
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A N A C T
RELATING TO HEALTH AND SAFETY -- EQUITABLE ACCESS PRIMARY CARE
PRACTICES ACT

Introduced By:
Representatives Hopkins, Cruz, J. Brien, Casimiro, Cotter, Boylan,
Shanley, Phillips, and Lima

Date Introduced:
March 20, 2026

Referred To:
House Corporations
It is enacted by the General Assembly as follows:
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SECTION 1. Legislative findings.
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The general assembly finds and declares that:
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(1) All Rhode Islanders deserve timely, high quality primary care without access
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limitations;
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(2) Primary care practices face challenges including administrative burdens, physician
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shortages, and burnout, which threaten overall access to care;
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(3) Innovative models can help sustain practices and improve convenience while
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preserving equity, but must never result in a pay to play system where ability to pay determines the
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quality or speed of essential medical care;
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(4) Optional fees for non-covered services can support practice viability if they are strictly
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voluntary, transparent, and do not affect access to or delivery of covered, medically necessary
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primary care services;
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(5) Maintaining reasonable panel sizes for licensed practitioners is the key to a healthy
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workforce and cared-for constituency. Innovative models can provide primary care practices the
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opportunity to maintain reasonable panel sizes while growing the practice to service more patients;
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(6) The goal of this legislation is to enhance access to care, not limit it, as well as protect
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some of our most valuable healthcare resources, primary care practitioners;
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(7) In order to maintain access for all Rhode Island patients, regardless of ability to

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participate in membership-model tiers, private practices must be made viable for growth and
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stability.
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SECTION 2. Title 23 of the General Laws entitled "HEALTH AND SAFETY" is hereby
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amended by adding thereto the following chapter:
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CHAPTER 106
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EQUITABLE ACCESS PRIMARY CARE PRACTICES ACT
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23-106-1. Short title.

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This chapter shall be known and may be cited as the "Equitable Access Primary Care
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Practices Act."
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23-106-2. Definitions.

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As used in this chapter, the following terms have the following meanings:
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(1) “Access fee” or “membership fee” means an optional, voluntary annual or periodic fee
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charged solely for non-covered services and conveniences not reimbursable by any third-party
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payer and not required for any medically necessary covered service.
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(2) “Equitable access primary care practice” means a primary care practice that:
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(i) Accepts and bills third-party payers, including commercial insurers, Medicare,
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Medicaid, and other government payers, for covered health services in full compliance with law
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and contracts; and
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(ii) May offer patients the voluntary choice of access tiers for non-covered services,
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including:
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(A) A tiered system of non-covered services, including the option for access to care without
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financial purchase beyond general third-party or self-pay fee schedules.
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(3) “Non-covered services” means conveniences such as coordination of non-covered
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testing, enhanced availability or priority scheduling that do not include or substitute for medically
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necessary covered services and are not billable to payers.
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(4) “Primary care practice” means a medical practice licensed in Rhode Island providing
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primary care through licensed physicians, physician assistants, or nurse practitioners, and owned
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and operated by licensed physicians or nurse practitioners.
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(5) “Third-party payer” means any health insurer, health maintenance organization,
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Medicare, Medicaid, or other government payer program.
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23-106-3. Authorization and strict equity requirements.

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(a) A licensed primary care practice may offer voluntary access fees for non-covered
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services as described in § 23-106-2(2)(ii), in addition to billing third-party payers for covered
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services.

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(b) Access fees shall apply exclusively to non-covered services. Practices shall not bill
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payers for these fees, apply them to deductibles, copayments, or coinsurance, or submit claims for
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them.
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(c) No patient shall be required to pay any access fee to:
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(1) Receive any medically necessary covered service;
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(2) Access emergency, urgent, or same day care when clinically indicated; or
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(3) Receive equal clinical attention, treatment quality, or medical decision making.
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(d) All patients, regardless of tier, shall receive identical standards of medical care,
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provider expertise for covered services, and nondiscrimination in clinical prioritization based on
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medical need rather than financial tier.
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23-106-4. Robust patient protections and transparency.

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(a) Before any patient elects a tier, the practice shall obtain signed informed consent in
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plain language that explicitly states:
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(1) The access fee is completely optional and pays only for conveniences such as faster
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scheduling or enhanced availability and not for better medical treatment;
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(2) Choosing the basic tier without a fee does not result in inferior care, longer waits for
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urgent needs, or any disadvantage in clinical outcomes; and
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(3) Fees are not insurance, are not reimbursable by any payer, and do not count toward
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insurance obligations.
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(b) Practices shall not deny, delay, downgrade, or otherwise disadvantage medically
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necessary care based on tier choice or inability or unwillingness to pay a fee. Urgent or emergent
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needs shall take precedence over scheduling preferences.
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23-106-5. Prohibition on insurer interference and safeguards.

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(a) No health insurer or third-party payer regulated by the state shall prohibit, penalize, or
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restrict a provider from offering voluntary non-covered amenity tiers; provided that, all covered
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services are billed and delivered equitably.
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(b) This section shall not override federal Medicare rules concerning beneficiary
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protections, assignment, or opt-out requirements.
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23-106-6. Medicaid and Medicare compliance.

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The executive office of health and human services shall issue rules and regulations within
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one hundred eighty (180) days of the effective date of this chapter to ensure that Medicaid providers
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may offer non-covered amenity fees consistent with federal rules and without charging
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beneficiaries for covered services. Nothing in this chapter authorizes fees that violate Medicare
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statutes or beneficiary protections.

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23-106-7. Enforcement and penalties.

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The department of health and the office of the health insurance commissioner shall enforce
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the provisions of this chapter. Violations that threaten patient equity may result in sanctions
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pursuant to chapter 37 of title 5 or title 27, including fines, license restrictions, or corrective action
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plans. The department shall adopt rules and regulations to monitor and promote equitable access.
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23-106-8. Severability.

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If any provision of this chapter or its application is held invalid, the remainder shall remain
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in effect.
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SECTION 3. This act shall take effect upon passage.
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EXPLANATION
BY THE LEGISLATIVE COUNCIL
OF
A N A C T
RELATING TO HEALTH AND SAFETY -- EQUITABLE ACCESS PRIMARY CARE
PRACTICES ACT
***
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This act would allow primary care practices to offer optional fees for non-covered services
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while requiring equal medical care for all patients and protecting access to medically necessary
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services regardless of ability to pay.
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This act would take effect upon passage.
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