AN ACT RELATING TO INSURANCE -- MEDICAID AND COMMERCIAL PRIMARY CARE RATE ENHANCEMENT AND SUSTAINABILITY ACT (Expands the patient-centered medical home program to all Medicaid-accepting independent primary care practices and nurse practitioners and increases reimbursement rates to match Massachusetts and Connecticut rates.)

H8335

2026 -- H 8335
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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 INSURANCE -- MEDICAID AND COMMERCIAL PRIMARY CARE RATE
ENHANCEMENT AND SUSTAINABILITY ACT

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

Date Introduced:
March 20, 2026

Referred To:
House Finance
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 that independent primary care practices face unsustainable
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overhead increases and reimbursement compression, resulting in closures and patient displacement.
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Commercial primary care rates in Rhode Island lag approximately twenty-nine percent (29%)
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behind neighboring states. State-directed payments under 42 C.F.R. § 438.6(c) provide a no-net-
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cost mechanism to stabilize these practices using existing Medicaid funds and federal matching
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dollars. Enhanced rates, supplements, and commercial parity are essential to prevent further
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closures and reduce system-wide costs.
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SECTION 2. Title 27 of the General Laws entitled "INSURANCE" is hereby amended by
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adding thereto the following chapter:
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CHAPTER 18.10
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MEDICAID AND COMMERCIAL PRIMARY CARE RATE ENHANCEMENT AND
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SUSTAINABILITY ACT
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27-18.10-1. Short title.
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This chapter shall be known and may be cited as the “Medicaid and Commercial Primary
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Care Rate Enhancement and Sustainability Act”
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27-18.10-2. Patient-centered medical home expansion and enhanced per-member-
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per-month supplements.

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(a) The executive office of health and human services (EOHHS) shall expand the patient-
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centered medical home (PCMH) program to all Medicaid-accepting independent primary care
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practices and nurse practitioners.
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(b) Through state-directed payments under 42 C.F.R. § 438.6(c), EOHHS shall require
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managed care organizations (MCOs) to pay an enhanced per-member-per-month (PMPM)
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supplement of ten dollars ($10.00) to twenty dollars ($20.00) for each attributed Medicaid patient
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to eligible independent providers who enroll in PCMH or meet equivalent criteria.
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27-18.10-3. Rate acceleration; Automatic per-member-per-month access payments
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and bonus.
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(a) EOHHS shall accelerate the FY2026 primary care rate increase to one hundred percent
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(100%) of Medicare and add a temporary twenty-five percent (25%) bonus for independent (non-
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hospital-employed) practices.
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(b) Through state-directed payments under 42 C.F.R. § 438.6(c), EOHHS shall require
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MCOs to pay an automatic access payment supplement of eight dollars ($8.00) to fifteen dollars
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($15.00) PMPM for every attributed Medicaid patient in qualifying independent practices.
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27-18.10-4. Commercial rate parity.
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The office of the health insurance commissioner shall require commercial insurers and
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Medicare Advantage plans to align primary care reimbursement rates with those in Massachusetts
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and Connecticut (approximately twenty-nine percent (29%) higher on average) through phased
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implementation: fifteen percent (15%) by January 1, 2027 and full alignment by July 1, 2027.
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27-18.10-5. Eligibility and implementation.
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(a) Eligibility is limited to independent primary care physicians and nurse practitioners
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who accept Medicaid and meet minimal quality and reporting requirements established by EOHHS.
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(b) On and after January 1, 2027, EOHHS shall:
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(1) Submit the necessary state-directed payment preprints to the centers for Medicare &
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Medicaid services;
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(2) Update all MCO contracts to incorporate these payments;
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(3) Build on the existing multi-payer PCMH program administered by the office of the
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health insurance commissioner (OHIC) in consultation with the Care Transformation Collaborative
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of Rhode Island (CTC-RI); and
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(4) Issue annual reports on access, retention, and cost savings.
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(c) The office of the health insurance commissioner shall amend regulations and insurer
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contracts to enforce commercial parity.
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27-18.10-6. Enforcement.

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The office of the health insurance commissioner and EOHHS shall enforce this chapter
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under existing authority. Non-compliant contract provisions are void.
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SECTION 3. This act shall take effect on January 1, 2027.
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EXPLANATION
BY THE LEGISLATIVE COUNCIL
OF
A N A C T
RELATING TO INSURANCE -- MEDICAID AND COMMERCIAL PRIMARY CARE RATE
ENHANCEMENT AND SUSTAINABILITY ACT
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This act would enact the Medicaid and commercial primary care rate enhancement and
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sustainability act, expanding the patient-centered medical home program to all Medicaid-accepting
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independent primary care practices and nurse practitioners. This act would increase rates paid by
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commercial insurers and Medicare Advantage plans to align with the reimbursement rates in
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Massachusetts and Connecticut starting with a fifteen percent (15%) increase on January 1,
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2027and full alignment by July 1, 2027.
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This act would take effect on January 1, 2027.
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