H7542

	2014 -- H 7542
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	LC004399
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	STATE OF RHODE ISLAND
	IN GENERAL ASSEMBLY
	JANUARY SESSION, A.D. 2014
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	A N A C T
	RELATING TO HEALTH AND SAFETY -- HEALTH CARE ACCESSIBILITY AND
	QUALITY ASSURANCE ACT

	Introduced By: Representatives Carnevale, San Bento, Lima, Slater, and Keable
	Date Introduced: February 26, 2014
	Referred To: House Corporations
	It is enacted by the General Assembly as follows:
1	SECTION 1. Chapter 23-17.13 of the General Laws entitled "Health Care Accessibility
2	and Quality Assurance Act" is hereby amended by adding thereto the following section:
3	23-17.13-7. Contracts with providers and optometric services. – (a) No contract
4	between an optometrist as defined in chapter 35.1 of title 5 and an insurer, including a company
5	offering accident and sickness insurance as defined in chapter 18 of title 27, a nonprofit hospital
6	service corporation as defined in chapter 19 of title 27, a nonprofit medical service corporation as
7	defined in chapter 20 of title 27, or a health maintenance organization as defined in chapter 41 of
8	title 27, or a vision plan, may require that an optometrist provide services or materials to its
9	subscribers at a fee set by the insurer or vision plan unless the insurer or vision plan compensates
10	the optometrist for the provision of such services or materials to the patient. Reimbursement paid
11	by the insurer or vision plan for covered services and materials shall be reasonable and shall not
12	provide nominal reimbursement in order to claim that services and materials are covered services.
13	(b)(1) "Services" means services and materials for which reimbursement from the vision
14	plan is provided for by an enrollee's plan contract, or for which a reimbursement would be
15	available but for the application of the enrollee's contractual limitations of deductibles,
16	copayments, or coinsurance.
17	(2) "Materials" means and includes, but is not limited to, lenses, devices containing
18	lenses, prisms, lens treatments and coatings, contact lenses, orthoptics, vision training, and

1	prosthetic devices to correct, relieve or treat defects or abnormal conditions of the human eye or
2	its adnexa.
3	SECTION 2. 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 -- HEALTH CARE ACCESSIBILITY AND
	QUALITY ASSURANCE ACT
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1	This act would provide that no contract between an insurance company or similar entity
2	and an optometrist would require the optometrist to provide services to a subscriber at a price set
3	by the insurer, unless the services were covered under the applicable insurance agreement.
4	This act would take effect upon passage.
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