Bill Sponsors
de la Cruz, Ciccone, Valverde, and Rogers
Committee
Senate Health & Human Services
Summary
Select
This legislation mandates that the Executive Office of Health and Human Services (EOHHS) create a system to pay for "community medical services" provided to Medicaid recipients. These services can be delivered by professionals such as paramedics, emergency medical technicians (EMTs), nurses, and physicians. Eligibility is targeted at patients who frequently use the emergency room or are at risk of hospitalization or nursing home admission. The services, which must be ordered by a primary care provider, include health assessments, medication monitoring, and minor medical procedures, aiming to provide care in the community rather than in institutional settings.
Sponsor
Analysis
Pros for Progressives
- Expands access to healthcare for vulnerable, low-income populations by bringing medical services directly to them, overcoming transportation barriers that often prevent poor communities from receiving care.
- Strengthens the social safety net by providing alternatives to institutionalization, allowing elderly and disabled individuals to age in place and remain in their communities rather than being forced into nursing homes.
- Promotes a holistic, preventative approach to public health by utilizing paramedics and EMTs for chronic disease management, which can improve long-term health outcomes for underserved groups.
Cons for Progressives
- The reliance on federal approval for implementation introduces uncertainty, potentially delaying critical services for those in need if the federal government acts slowly or denies the request.
- While expanding services, the bill does not explicitly mandate wage increases or specific labor protections for the paramedics and EMTs who will be taking on these additional responsibilities.
- The eligibility requirement of three emergency room visits in four months creates a reactive threshold, potentially forcing patients to undergo significant health crises before they qualify for this preventative support.
Pros for Conservatives
- Reduces the burden on taxpayers by diverting patients from expensive emergency room visits and nursing home stays to more cost-effective community-based care models.
- Maximizes the efficiency of the existing healthcare workforce by utilizing paramedics and EMTs for billable services during non-emergency downtime, rather than expanding government hiring.
- Includes strict guardrails against fraud and waste by requiring physician orders, care coordination to prevent duplicate services, and federal approval before spending begins.
Cons for Conservatives
- Expands the scope of the state Medicaid program, increasing government involvement in the healthcare sector and potentially creating long-term fiscal obligations.
- Grants broad regulatory authority to the Department of Health and EOHHS to define rules and minor procedures, increasing bureaucratic control over medical practices.
- Increases state reliance on federal funding and approval, further entangling Rhode Island's healthcare system with federal mandates and strings attached to Medicaid dollars.
Constitutional Concerns
None Likely
Impact Overview
Groups Affected
- Medicaid Recipients
- Paramedics and EMTs
- Hospitals and Emergency Departments
- Nursing Facilities
- Primary Care Providers
Towns Affected
All
Cost to Taxpayers
Amount unknown
Revenue Generated
None
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Bill Status
Current Status
Held
Comm Passed
Floor Passed
Law
History
• 01/16/2026 Introduced, referred to Senate Health and Human Services
Bill Text
SECTION 1. Chapter 40-8 of the General Laws entitled "Medical Assistance" is hereby amended by adding thereto the following section:
40-8-33. Community medical services.
(a) The executive office of health and human services (EOHHS) shall adopt and implement a methodology for medical assistance reimbursement for services provided by licensed medical service providers acting in their capacity as community medical service providers, to include physicians, nurses, physician assistants, paramedics, and emergency medical technicians when services are provided in accordance with this section to eligible recipients pursuant to the provisions of § 40-8-3.
(b) An eligible recipient shall be qualified for coverage pursuant to this section, if as an individual they have received hospital emergency department services three (3) or more times in a period of four (4) consecutive months in the past twelve (12) months or have been identified by the individual's primary health care provider for whom community medical services, as provided in subsection (c) of this section, would likely prevent admission to or would allow discharge from a nursing facility; or would likely prevent readmission to a hospital or nursing facility.
(c) Payment for services provided by a community medical service provider pursuant to this section shall be a part of a care plan ordered by a primary health care provider and shall be billed by an eligible provider enrolled in medical assistance that employs or contracts with the community medical service provider. The care plan shall ensure that the services provided by a community medical service provider are coordinated with other community health providers and local public health agencies, and that the community medical services do not duplicate services already provided to the patient, including existing home health care or waiver services. Community medical services shall include health assessment, chronic disease monitoring and education, medication compliance, immunizations and vaccinations, laboratory specimen collection, hospital discharge follow-up care, and minor medical procedures approved by the director of the department of health.
(d) Services provided by a community medical service provider to an eligible recipient who is also receiving care coordination services shall be in consultation with the providers of the recipient's care coordination services.
(e) Nothing in this section shall be construed to authorize any medical service provider to provide services beyond or outside the scope of their training or license authorization.
(f) The director of the department of health may promulgate rules and regulations to implement the method and manner of health care services to be provided pursuant to the provisions of this section.
(g) The department of human services or EOHHS shall seek federal approval to implement the provision of this section.
SECTION 2. This act shall take effect upon passage.
40-8-33. Community medical services.
(a) The executive office of health and human services (EOHHS) shall adopt and implement a methodology for medical assistance reimbursement for services provided by licensed medical service providers acting in their capacity as community medical service providers, to include physicians, nurses, physician assistants, paramedics, and emergency medical technicians when services are provided in accordance with this section to eligible recipients pursuant to the provisions of § 40-8-3.
(b) An eligible recipient shall be qualified for coverage pursuant to this section, if as an individual they have received hospital emergency department services three (3) or more times in a period of four (4) consecutive months in the past twelve (12) months or have been identified by the individual's primary health care provider for whom community medical services, as provided in subsection (c) of this section, would likely prevent admission to or would allow discharge from a nursing facility; or would likely prevent readmission to a hospital or nursing facility.
(c) Payment for services provided by a community medical service provider pursuant to this section shall be a part of a care plan ordered by a primary health care provider and shall be billed by an eligible provider enrolled in medical assistance that employs or contracts with the community medical service provider. The care plan shall ensure that the services provided by a community medical service provider are coordinated with other community health providers and local public health agencies, and that the community medical services do not duplicate services already provided to the patient, including existing home health care or waiver services. Community medical services shall include health assessment, chronic disease monitoring and education, medication compliance, immunizations and vaccinations, laboratory specimen collection, hospital discharge follow-up care, and minor medical procedures approved by the director of the department of health.
(d) Services provided by a community medical service provider to an eligible recipient who is also receiving care coordination services shall be in consultation with the providers of the recipient's care coordination services.
(e) Nothing in this section shall be construed to authorize any medical service provider to provide services beyond or outside the scope of their training or license authorization.
(f) The director of the department of health may promulgate rules and regulations to implement the method and manner of health care services to be provided pursuant to the provisions of this section.
(g) The department of human services or EOHHS shall seek federal approval to implement the provision of this section.
SECTION 2. This act shall take effect upon passage.