2014 -- H 7920

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LC003786

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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 INSURANCE - HEALTH INSURANCE POLICIES

     Introduced By: Representatives Silva, and Serpa

     Date Introduced: March 13, 2014

     Referred To: House Corporations

     It is enacted by the General Assembly as follows:

     SECTION 1. Section 27-18-1.1 of the General Laws in Chapter 27-18 entitled "Accident

and Sickness Insurance Policies" is hereby amended to read as follows:

     27-18-1.1. Definitions. -- As used in this chapter:

      (1) "Adverse benefit determination" means any of the following: a denial, reduction, or

termination of, or a failure to provide or make payment (in whole or in part) for, a benefit,

including any such denial, reduction, termination, or failure to provide or make payment that is

based on a determination of an individual's eligibility to participate in a plan or to receive

coverage under a plan, and including, with respect to group health plans, a denial, reduction, or

termination of, or a failure to provide or make payment (in whole or in part) for, a benefit

resulting from the application of any utilization review, as well as a failure to cover an item or

service for which benefits are otherwise provided because it is determined to be experimental or

investigational or not medically necessary or appropriate. The term also includes a rescission of

coverage determination.

      (2) "Affordable Care Act" means the federal Patient Protection and Affordable Care Act

of 2010, as amended by the federal Health Care and Education Reconciliation Act of 2010, and

federal regulations adopted thereunder.

      (3) "Commissioner" or "health insurance commissioner" means that individual appointed

pursuant to section 42-14.5-1 of the general laws.

      (4) "Essential health benefits" shall have the meaning set forth in section 1302(b) of the

federal Affordable Care Act,

      (5) "Grandfathered health plan" means any group health plan or health insurance

coverage subject to 42 USC section 18011.

      (6) "Group health insurance coverage" means, in connection with a group health plan,

health insurance coverage offered in connection with such plan.

      (7) "Group health plan" means an employee welfare benefit plan, as defined in 29 USC

section 1002(1), to the extent that the plan provides health benefits to employees or their

dependents directly or through insurance, reimbursement, or otherwise.

      (8) "Health benefits" or "covered benefits" means coverage or benefits for the diagnosis,

cure, mitigation, treatment, or prevention of disease, or amounts paid for the purpose of affecting

any structure or function of the body including coverage or benefits for transportation primarily

for and essential thereto, and including medical services as defined in R.I. Gen. Laws section 27-

19-17;

      (9) "Health care facility" means an institution providing health care services or a health

care setting, including, but not limited to, hospitals and other licensed inpatient centers,

ambulatory surgical or treatment centers, skilled nursing centers, residential treatment centers,

diagnostic, laboratory and imaging centers, and rehabilitation and other therapeutic health

settings.

      (10) "Health care professional" means a physician or other health care practitioner

licensed, accredited or certified to perform specified health care services consistent with state

law.

      (11) "Health care provider" or "provider" means a health care professional or a health

care facility.

      (12) "Health care services" means services for the diagnosis, prevention, treatment, cure

or relief of a health condition, illness, injury or disease.

      (13) "Health insurance carrier" means a person, firm, corporation or other entity subject

to the jurisdiction of the commissioner under this chapter. Such term does not include a group

health plan.

      (14) "Health plan" or "health benefit plan" means health insurance coverage and a group

health plan, including coverage provided through an association plan if it covers Rhode Island

residents. Except to the extent specifically provided by the federal Affordable Care Act, the term

"health plan" shall not include a group health plan to the extent state regulation of the health plan

is pre-empted under section 514 of the federal Employee Retirement Income Security Act of

1974. The term also shall not include:

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      (A) (i) Coverage only for accident, or disability income insurance, or any combination

thereof.

      (ii) Coverage issued as a supplement to liability insurance.

      (iii) Liability insurance, including general liability insurance and automobile liability

insurance.

      (iv) Workers' compensation or similar insurance.

      (v) Automobile medical payment insurance.

      (vi) Credit-only insurance.

      (vii) Coverage for on-site medical clinics.

      (viii) Other similar insurance coverage, specified in federal regulations issued pursuant

to Pub. L. No. 104-191, the federal health insurance portability and accountability act of 1996

("HIPAA"), under which benefits for medical care are secondary or incidental to other insurance

benefits.

      (B) The following benefits if they are provided under a separate policy, certificate or

contract of insurance or are otherwise not an integral part of the plan:

      (i) Limited scope dental or vision benefits.

      (ii) Benefits for long-term care, nursing home care, home health care, community-based

care, or any combination thereof.

      (iii) Other excepted benefits specified in federal regulations issued pursuant to federal

Pub. L. No. 104-191 ("HIPAA").

      (C) The following benefits if the benefits are provided under a separate policy, certificate

or contract of insurance, there is no coordination between the provision of the benefits and any

exclusion of benefits under any group health plan maintained by the same plan sponsor, and the

benefits are paid with respect to an event without regard to whether benefits are provided with

respect to such an event under any group health plan maintained by the same plan sponsor:

      (i) Coverage only for a specified disease or illness.

      (ii) Hospital indemnity or other fixed indemnity insurance.

      (D) The following if offered as a separate policy, certificate or contract of insurance:

      (i) Medicare supplement health insurance as defined under section 1882(g)(1) of the

federal Social Security Act.

      (ii) Coverage supplemental to the coverage provided under chapter 55 of title 10, United

States Code (Civilian Health and Medical Program of the Uniformed Services (CHAMPUS)).

      (iii) Similar supplemental coverage provided to coverage under a group health plan.

      (15) "Office of the health insurance commissioner" means the agency established under

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section 42-14.5-1 of the General laws.

      (16) "Rescission" means a cancellation or discontinuance of coverage that has retroactive

effect for reasons unrelated to timely payment of required premiums or contribution to costs of

coverage.

     (17) "MC5-A scrambler therapy" means a type of treatment for nerve pain that uses

electrodes placed on the skin. Electricity is carried from the electrodes through the skin and

blocks the pain. The pain may be caused by physical injury, infection, toxic substances, and

certain diseases or drugs, including anticancer drugs.

     SECTION 2. Chapter 27-18 of the General Laws entitled "Accident and Sickness

Insurance Policies" is hereby amended by adding thereto the following section:

     27-18-82. MC5-A scrambler therapy mandatory coverage. – Every individual or

group hospital or medical expense insurance policy or individual or group hospital or medical

services plan contract delivered, issued for delivery, or renewed in this state on or after January 1,

2015 shall provide coverage for MC5-A scrambler therapy.

     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 INSURANCE - HEALTH INSURANCE POLICIES

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     This act would require every individual or group hospital or medical expense insurance

policy or individual or group hospital or medical services plan contract delivered, issued for

delivery, or renewed in this state on or after January 1, 2015 to provide coverage for MC5-A

scrambler therapy.

     This act would take effect upon passage.

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