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H8500
2026 -- H 8500
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LC004971
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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 STATE AFFAIRS AND GOVERNMENT -- OFFICE OF HEALTH AND
HUMAN SERVICES
Introduced By:
Representatives Donovan, Speakman, Boylan, McGaw, Cotter, Carson,
Kislak, Potter, Giraldo, and Stewart
Date Introduced:
May 01, 2026
Referred To:
House Health & Human Services
(Dept. of Executive Office of Health and Human Services)
It is enacted by the General Assembly as follows:
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SECTION 1. Section 42-7.2-5 of the General Laws in Chapter 42-7.2 entitled "Office of
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Health and Human Services" is hereby amended to read as follows:
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42-7.2-5. Duties of the secretary.
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The secretary shall be subject to the direction and supervision of the governor for the
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oversight, coordination, and cohesive direction of state-administered health and human services
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and in ensuring the laws are faithfully executed, notwithstanding any law to the contrary. In this
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capacity, the secretary of the executive office of health and human services (EOHHS) shall be
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authorized to:
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(1)
Coordinate
Oversee and direct
the administration and financing of healthcare benefits,
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human services,
systems of care,
and programs including those authorized by the state’s Medicaid
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section 1115 demonstration waiver and, as applicable, the Medicaid state plan under Title XIX of
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the U.S. Social Security Act. However, nothing in this section shall be construed as transferring to
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the secretary the powers, duties, or functions conferred upon the departments by Rhode Island
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public and general laws for the administration of federal/state programs financed in whole or in
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part with Medicaid funds or the administrative responsibility for the preparation and submission of
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any state plans, state plan amendments, or authorized federal waiver applications, once approved
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by the secretary.
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(2) Serve as the governor’s chief advisor and liaison to federal policymakers on Medicaid
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reform issues as well as the principal point of contact in the state on any such related matters.
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(3)(i) Review and ensure the coordination of the state’s Medicaid section 1115
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demonstration waiver requests and renewals as well as any initiatives and proposals requiring
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amendments to the Medicaid state plan or formal amendment changes, as described in the special
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terms and conditions of the state’s Medicaid section 1115 demonstration waiver with the potential
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to affect the scope, amount, or duration of publicly funded healthcare services, provider payments
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or reimbursements, or access to or the availability of benefits and services as provided by Rhode
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Island general and public laws. The secretary shall consider whether any such changes are legally
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and fiscally sound and consistent with the state’s policy and budget priorities. The secretary shall
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also assess whether a proposed change is capable of obtaining the necessary approvals from federal
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officials and achieving the expected positive consumer outcomes. Department directors shall,
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within the timelines specified, provide any information and resources the secretary deems necessary
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in order to perform the reviews authorized in this section.
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(ii) Direct the development and implementation of any Medicaid policies, procedures, or
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systems that may be required to assure successful operation of the state’s health and human services
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integrated eligibility system and coordination with HealthSource RI, the state’s health insurance
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marketplace.
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(iii) Beginning in 2015, conduct on a biennial basis a comprehensive review of the
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Medicaid eligibility criteria for one or more of the populations covered under the state plan or a
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waiver to ensure consistency with federal and state laws and policies, coordinate and align systems,
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and identify areas for improving quality assurance, fair and equitable access to services, and
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opportunities for additional financial participation.
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(iv) Implement service organization and delivery reforms that facilitate service integration,
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increase value, and improve quality and health outcomes.
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(4) Beginning in 2020, prepare and submit to the governor, the chairpersons of the house
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and senate finance committees, the caseload estimating conference, and to the joint legislative
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committee for health-care oversight, by no later than September 15 of each year, a comprehensive
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overview of all Medicaid expenditures outcomes, administrative costs, and utilization rates. The
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overview shall include, but not be limited to, the following information:
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(i) Expenditures under Titles XIX and XXI of the Social Security Act, as amended;
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(ii) Expenditures, outcomes, and utilization rates by population and sub-population served
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(e.g., families with children, persons with disabilities, children in foster care, children receiving
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adoption assistance, adults ages nineteen (19) to sixty-four (64), and elders);
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(iii) Expenditures, outcomes, and utilization rates by each state department or other
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municipal or public entity receiving federal reimbursement under Titles XIX and XXI of the Social
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Security Act, as amended;
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(iv) Expenditures, outcomes, and utilization rates by type of service and/or service
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provider;
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(v) Expenditures by mandatory population receiving mandatory services and, reported
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separately, optional services, as well as optional populations receiving mandatory services and,
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reported separately, optional services for each state agency receiving Title XIX and XXI funds; and
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(vi) Information submitted to the Centers for Medicare & Medicaid Services for the
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mandatory annual state reporting of the Core Set of Children’s Health Care Quality Measures for
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Medicaid and Children’s Health Insurance Program, behavioral health measures on the Core Set of
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Adult Health Care Quality Measures for Medicaid and the Core Sets of Health Home Quality
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Measures for Medicaid to ensure compliance with the Bipartisan Budget Act of 2018, Pub. L. No.
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115-123.
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The directors of the departments, as well as local governments and school departments,
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shall assist and cooperate with the secretary in fulfilling this responsibility by providing whatever
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resources, information, and support shall be necessary.
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(5) Resolve administrative, jurisdictional, operational, program, or policy conflicts among
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departments and their executive staffs and make necessary recommendations to the governor.
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(6) Ensure continued progress toward improving the quality, the economy, the
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accountability, and the efficiency of state-administered health and human services. In this capacity,
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the secretary shall:
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(i) Direct implementation of reforms in the human resources practices of the executive
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office and the departments that streamline and upgrade services, achieve greater economies of scale
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and establish the coordinated system of the staff education, cross-training, and career development
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services necessary to recruit and retain a highly-skilled, responsive, and engaged health and human
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services workforce;
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(ii) Encourage EOHHS-wide consumer-centered approaches to service design and delivery
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that expand their capacity to respond efficiently and responsibly to the diverse and changing needs
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of the people and communities they serve;
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(iii) Develop all opportunities to maximize resources by leveraging the state’s purchasing
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power, centralizing fiscal service functions related to budget, finance, and procurement,
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centralizing communication, policy analysis and planning, and information systems and data
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management, pursuing alternative funding sources through grants, awards, and partnerships and
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securing all available federal financial participation for programs and services provided EOHHS-
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wide;
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(iv) Improve the coordination and efficiency of health and human services legal functions
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by centralizing adjudicative and legal services and overseeing their timely and judicious
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administration;
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(v) Facilitate the rebalancing of the long-term system by creating an assessment and
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coordination organization or unit for the expressed purpose of developing and implementing
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procedures EOHHS-wide that ensure that the appropriate publicly funded health services are
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provided at the right time and in the most appropriate and least restrictive setting;
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(vi) Strengthen health and human services program integrity, quality control and
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collections, and recovery activities by consolidating functions within the office in a single unit that
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ensures all affected parties pay their fair share of the cost of services and are aware of alternative
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financing;
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(vii) Assure protective services are available to vulnerable elders and adults with
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developmental and other disabilities by reorganizing existing services, establishing new services
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where gaps exist, and centralizing administrative responsibility for oversight of all related
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initiatives and programs.
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(7) Prepare and integrate comprehensive budgets for the health and human services
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departments and any other functions and duties assigned to the office. The budgets shall be
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submitted to the state budget office by the secretary, for consideration by the governor, on behalf
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of the state’s health and human services agencies in accordance with the provisions set forth in §
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35-3-4.
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(8) Utilize objective data to evaluate health and human services policy goals, resource use
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and outcome evaluation and to perform short and long-term policy planning and development.
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(9) Establish an integrated approach to interdepartmental information and data
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management that complements and furthers the goals of the unified health infrastructure project
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initiative and that will facilitate the transition to a consumer-centered integrated system of state-
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administered health and human services.
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(10) At the direction of the governor or the general assembly, conduct independent reviews
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of state-administered health and human services programs, policies, and related agency actions and
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activities and assist the department directors in identifying strategies to address any issues or areas
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of concern that may emerge thereof. The department directors shall provide any information and
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assistance deemed necessary by the secretary when undertaking such independent reviews.
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(11) Provide regular and timely reports to the governor and make recommendations with
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respect to the state’s health and human services agenda.
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(12) Employ such personnel and contract for such consulting services as may be required
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to perform the powers and duties lawfully conferred upon the secretary.
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(13) Assume responsibility for complying with the provisions of any general or public law
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or regulation related to the disclosure, confidentiality, and privacy of any information or records,
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in the possession or under the control of the executive office or the departments assigned to the
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executive office, that may be developed or acquired or transferred at the direction of the governor
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or the secretary for purposes directly connected with the secretary’s duties set forth herein.
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(14) Hold the director of each health and human services department accountable for their
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administrative, fiscal, and program actions in the conduct of the respective powers and duties of
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their agencies.
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(15) Identify opportunities for inclusion with the EOHHS’ October 1, 2023, budget
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submission, to remove fixed eligibility thresholds for programs under its purview by establishing
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sliding scale decreases in benefits commensurate with income increases up to four hundred fifty
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percent (450%) of the federal poverty level. These shall include but not be limited to, medical
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assistance, childcare assistance, and food assistance.
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(16) Ensure that insurers minimize administrative burdens on providers that may delay
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medically necessary care, including requiring that insurers do not impose a prior authorization
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requirement for any admission, item, service, treatment, or procedure ordered by an in-network
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primary care provider. Provided, the prohibition shall not be construed to prohibit prior
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authorization requirements for prescription drugs. Provided further, that as used in this subsection
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(16) of this section, the terms “insurer,” “primary care provider,” and “prior authorization” means
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the same as those terms are defined in § 27-18.9-2.
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(17) The secretary shall convene, in consultation with the governor, an advisory working
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group to assist in the review and analysis of potential impacts of any adopted federal actions related
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to Medicaid programs. The working group shall develop options for administrative action or
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general assembly consideration that may be needed to address any federal funding changes that
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impact Rhode Island’s Medicaid programs.
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(i) The advisory working group may include, but not be limited to, the secretary of health
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and human services, director of management and budget, and designees from the following: state
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agencies, businesses, healthcare, public sector unions, and advocates.
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(ii) As soon as practicable after the enactment federal budget for fiscal year 2026, but no
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later than October 31, 2025, the advisory working group shall forward a report to the governor,
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speaker of the house, and president of the senate containing the findings, recommendations and
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options for consideration to become compliant with federal changes prior to the governor’s budget
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submission pursuant to § 35-3-7.
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(18) Promote fiscal integrity, transparency, and accountability in the state's healthcare
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system.
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SECTION 2. Title 42 of the General Laws entitled "STATE AFFAIRS AND
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GOVERNMENT" is hereby amended by adding thereto the following chapter:
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CHAPTER 7.5
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HEALTHCARE ENTITY FISCAL INTEGRITY, TRANSPARENCY, AND
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ACCOUNTABILITY
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42-7.5-1. Definitions.
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For the purpose of this chapter:
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(1) “Assessment” means the review of the financial reports submitted by reporting covered
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entities for the purposes of identifying financial strengths, weaknesses, and risks, tracking
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utilization and capacity, and may be the basis of initiating any authorized remedies or corrective
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actions deemed necessary and appropriate to address financial risks in accordance with
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implementing regulations promulgated by the secretary of the executive office of health and human
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services (EOHHS).
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(2) “Audited financial statement” means the complete set of financial statements of a
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healthcare entity, including notes to the financial statements, which are subject to an independent
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audit in accordance with Generally Accepted Auditing Standards that certain reporting covered
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entities are required to submit to state and federal authorities. The quarterly reports required in this
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section should be approved by the governing board of the reporting covered entity although they
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are a supplement to and not a substitute for existing audited financial statement reporting
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requirements.
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(3) “Bad debt” means loans or outstanding balances owed that are no longer deemed
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recoverable and are journaled as uncollectible accounts.
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(4) “Department” means the executive office of health and human services.
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(5) “Financial risk” means the possibility of facing adverse financial and/or operational
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consequences based on criteria established by regulations promulgated pursuant to this chapter by
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the secretary of EOHHS.
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(6) “Fiscal integrity” means a financial system that operates in a transparent, and
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accountable way that promotes stability and solvency and in accordance with widely accepted
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financial rules and standards.
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(7) “Imminent financial jeopardy” means an assessment finding indicating that a reporting
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covered entity is in financial distress that poses an immediate threat and significant likelihood of
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financial insolvency, the ceasing of operations or admissions, the loss of licensure, accreditation,
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or certification for third party reimbursement, and/or the reduction of access to healthcare services
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to the extent that public health and safety may be adversely affected.
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(8) “Parent organization” means an entity that has a controlling interest in one or more
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subsidiary reporting covered entities.
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(9) “Quarterly financial report” means detailed information about a reporting covered
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entity’s finances prepared by the entity in accordance with a format and/or set of specific auditing
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principles to be determined by the secretary.
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(10) “Reporting covered entity” means:
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(i) Hospitals licensed by the department of health and actively operating under § 23-17-4
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and the associated implementing regulations established in 216-RICR-40-10-4, and their parent
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organizations.
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(ii) Nursing facilities licensed by the department of health and actively operating pursuant
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to § 23-17-4 and the associated implementing regulations set forth in 216-RICR-40-10-1, and their
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parent organizations.
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(iii) Federally qualified community health centers, hereinafter, FQHCs licensed by the state
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as a type of “organized ambulatory facility” in accordance with § 23-17-10 and implementing
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regulations at 216-RICR-40-10-3 and certified by the federal Centers for Medicare and Medicaid
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and the executive office of health and human services.
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(iv) Certified community behavioral health clinics (CCBHCs) as defined in § 40.1-8.5-8
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and certified and regulated by EOHHS with clinical oversight support provided by the department
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of behavioral healthcare, developmental disabilities and hospitals as the state’s substance abuse
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disorder and mental health authority and the department of children, youth and families as the
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state’s children’s mental health authority, operating under applicable federal law.
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(11) “Secretary” means the secretary of the executive office of health and human services.
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42-7.5-2. Quarterly reporting required.
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(a) Beginning October 1, 2026, reporting covered entities are required to submit quarterly
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financial reports including, but not limited to, balance sheet and income statement information
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showing cash on hand, accounts payable and accounts receivable, gross and net patient revenues,
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other income, operating costs by category, other expenses, investment income and non-patient
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services revenues, assets, liabilities, and net surplus or profit margin, uninsured and bad debt costs,
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and net charity care and any other information as may be required by the secretary.
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The secretary shall consider ease of data collection, submission, and analysis from the
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perspective of both the reporting covered entities and the EOHHS when selecting a report format
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and shall pursue electronic formats to the full extent feasible.
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(b) Reporting covered entities shall submit quarterly reports to the secretary no later than
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sixty (60) business days after the end date of the preceding filing quarter. Quarters are as follows:
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Q1: January 1–March 31; Q2: April 1–June 30; Q3: July 1–September 30; Q4: October 1–
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December 31.
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(c) Quarterly reports shall be signed by a reporting covered entity’s chief financial officer
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or authorized financial signatory and include an attestation to the truthfulness and validity of the
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information contained in the report at the time it was filed with the secretary.
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(d) The quarterly reports shall be reviewed and provide the basis for an assessment and
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analysis of each reporting covered entity’s financial status and capacity. The secretary shall develop
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a process for conducting assessments and analyses of the reports in a systematic, objective, and
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timely manner. The secretary shall, if applicable, make findings of financial risk or imminent
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financial jeopardy as defined in this chapter as well as any noteworthy findings at least thirty (30)
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days prior to the deadline for the next quarterly report submission. The secretary may seek technical
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advice and support to assist in establishing this process and ensuring that it leverages existing
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information technology to the full extent feasible, and utilizes available objective data analytic
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tools. The secretary shall request that reporting covered entities provide quarterly financial
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statements in a mutually agreed upon format until such time as a permanent format is required.
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(e) The secretary may also require a corrective action plan to address findings of financial
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risk, imminent financial jeopardy, or any other noteworthy finding.
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42-7.5-3. Notification -- Remedies -- Corrective actions.
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(a) Each reporting covered entity shall be notified of the dates of receipt of the report, the
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completion of the assessment and analyses, any finding of financial risk or imminent financial
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jeopardy, and any other additional information regarding the financial condition of the reporting
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covered entity. Consistent with the intent to ensure solvency of reporting covered entities, upon
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finding financial risk or imminent financial jeopardy, the secretary shall meet with the reporting
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covered entity to identify and document strategies to address the finding of financial risks or
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imminent financial jeopardy.
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(b) If EOHHS makes a finding of financial risk or imminent financial jeopardy, the
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notification shall include:
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(1) The possible range of corrective actions;
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(2) The obligations of their owner(s)/operator(s) to cooperate;
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(3) The requirement to provide a corrective action plan, follow-up reports, or any additional
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documentation that EOHHS may require and the associated due dates; and
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(4) Any actions that may be imposed on the reporting covered entity for failing to comply.
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(c) Any reporting covered entity that is required to provide an independent or other
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additional analyses including forensic audits as part of a corrective action plan is responsible for
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paying all associated costs.
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(d) The secretary is authorized to require any fiscally sound, necessary, and appropriate
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actions to mitigate the findings of financial risks or imminent financial jeopardy of the reporting
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covered entity to secure health system stability.
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(e) In circumstances in which government action may be warranted and no authority for
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such exists within the EOHHS, the department of health, the department of behavioral health,
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developmental disability, and hospitals, or any other state agency, the recommendations shall be
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forwarded forthwith to the governor for the prompt resolution of any imminent risks identified.
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42-7.5-4. Restrictions.
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Nothing in this chapter obligates EOHHS, the department of health, the department of
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behavioral health, developmental disability, and hospitals, or any other state agency, to provide
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financial assistance to a reporting covered entity with a finding of financial risk or imminent
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financial jeopardy.
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42-7.5-5. Disclosure.
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The secretary shall make available the findings from the required reports that is not
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otherwise protected as confidential or non-disclosable by federal or state laws and/or regulations.
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42-7.5-6. Federal authorities and financing opportunities.
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The secretary is authorized to pursue funding including, but not limited to, authorized
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Medicaid Federal Match opportunities, grants, and foundation awards to stabilize reporting covered
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entities found to be in imminent jeopardy and promote fiscal integrity, transparency and
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accountability in the state’s healthcare system.
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42-7.5-7. Rules and regulations.
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The secretary is authorized to promulgate rules and regulations to carry out the provisions,
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policies, and purposes of this chapter.
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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 STATE AFFAIRS AND GOVERNMENT -- OFFICE OF HEALTH AND
HUMAN SERVICES
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This act would promote fiscal integrity, transparency, and accountability in the state’s
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healthcare system by mandating that the reporting covered health entities identified therein submit
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quarterly financial reports to the secretary to facilitate the regular and timely assessment of their
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financial soundness and identify any entities that may be facing financial risks with the potential to
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affect the overall stability of the state’s healthcare system, equitable access to high-quality and
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affordable services, and the goals of the statewide health planning process.
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This act would take effect upon passage.
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