AN ACT RELATING TO HUMAN SERVICES -- MEDICAL ASSISTANCE (Provides medical assistance coverage for medical services provided qualifying eligible recipients for community based care.)

S2106

2026 -- S 2106
========
LC003345
========

STATE OF RHODE ISLAND
IN GENERAL ASSEMBLY
JANUARY SESSION, A.D. 2026
____________
A N A C T
RELATING TO HUMAN SERVICES -- MEDICAL ASSISTANCE

Introduced By:
Senators de la Cruz, Ciccone, Valverde, and Rogers

Date Introduced:
January 16, 2026

Referred To:
Senate Health & Human Services
It is enacted by the General Assembly as follows:
1
SECTION 1. Chapter 40-8 of the General Laws entitled "Medical Assistance" is hereby
2
amended by adding thereto the following section:
3

40-8-33. Community medical services.

4

(a) The executive office of health and human services (EOHHS) shall adopt and implement
5
a methodology for medical assistance reimbursement for services provided by licensed medical
6
service providers acting in their capacity as community medical service providers, to include
7
physicians, nurses, physician assistants, paramedics, and emergency medical technicians when
8
services are provided in accordance with this section to eligible recipients pursuant to the provisions
9
of § 40-8-3.
10

(b) An eligible recipient shall be qualified for coverage pursuant to this section, if as an
11
individual they have received hospital emergency department services three (3) or more times in a
12
period of four (4) consecutive months in the past twelve (12) months or have been identified by the
13
individual's primary health care provider for whom community medical services, as provided in
14
subsection (c) of this section, would likely prevent admission to or would allow discharge from a
15
nursing facility; or would likely prevent readmission to a hospital or nursing facility.
16

(c) Payment for services provided by a community medical service provider pursuant to
17
this section shall be a part of a care plan ordered by a primary health care provider and shall be
18
billed by an eligible provider enrolled in medical assistance that employs or contracts with the
19
community medical service provider. The care plan shall ensure that the services provided by a

1
community medical service provider are coordinated with other community health providers and
2
local public health agencies, and that the community medical services do not duplicate services
3
already provided to the patient, including existing home health care or waiver services. Community
4
medical services shall include health assessment, chronic disease monitoring and education,
5
medication compliance, immunizations and vaccinations, laboratory specimen collection, hospital
6
discharge follow-up care, and minor medical procedures approved by the director of the department
7
of health.
8

(d) Services provided by a community medical service provider to an eligible recipient who
9
is also receiving care coordination services shall be in consultation with the providers of the
10
recipient's care coordination services.
11

(e) Nothing in this section shall be construed to authorize any medical service provider to
12
provide services beyond or outside the scope of their training or license authorization.
13

(f) The director of the department of health may promulgate rules and regulations to
14
implement the method and manner of health care services to be provided pursuant to the provisions
15
of this section.
16

(g) The department of human services or EOHHS shall seek federal approval to implement
17
the provision of this section.
18
SECTION 2. This act shall take effect upon passage.
========
LC003345
========

LC003345 - Page 2 of 3
EXPLANATION
BY THE LEGISLATIVE COUNCIL
OF
A N A C T
RELATING TO HUMAN SERVICES -- MEDICAL ASSISTANCE
***
1
This act would provide medical assistance coverage for medical services provided to
2
qualifying eligible recipients for community-based care.
3
This act would take effect upon passage.
========
LC003345
========

LC003345 - Page 3 of 3