2014 -- S 2516 SUBSTITUTE A

========

LC004408/SUB A

========

     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2014

____________

A N   A C T

RELATING TO HEALTH AND SAFETY -- HEALTH CARE ACCESSIBILITY AND

QUALITY ASSURANCE ACT

     Introduced By: Senators Ciccone, Archambault, and Lombardi

     Date Introduced: February 27, 2014

     Referred To: Senate Health & Human Services

     It is enacted by the General Assembly as follows:

     SECTION 1. Chapter 23-17.13 of the General Laws entitled "Health Care Accessibility

and Quality Assurance Act" is hereby amended by adding thereto the following section:

     23-17.13-7. Contracts with providers and optometric services. – (a) No contract

between an eye care provider and a company offering accident and sickness insurance as defined

in chapter 18 of title 27; a nonprofit medical service corporation as defined in chapter 20 of title

27; or a health maintenance organization as defined in chapter 41 of title 27; or a vision plan, may

require that an eye care provider provide services or materials to its subscribers at a fee set by the

insurer or vision plan unless the insurer or vision plan compensates the eye care provider for the

provision of such services or materials to the patient. Reimbursement paid by the insurer or vision

plan for covered services and materials shall not provide nominal reimbursement in order to claim

that services and materials are covered services.

     (b)(1) "Services" means services and materials for which reimbursement from the vision

plan is provided for by an enrollee's plan contract, or for which a reimbursement would be

available but for the application of the enrollee's contractual limitations of deductibles,

copayments, or coinsurance.

     (2) "Materials" means and includes, but is not limited to, lenses, devices containing

lenses, prisms, lens treatments and coatings, contact lenses, orthoptics, vision training, and

prosthetic devices to correct, relieve, or treat defects or abnormal conditions of the human eye or

its adnexa.

     (3) "Eye care provider" means an optometrist, optician, or ophthalmologist.

     SECTION 2. This act shall take effect upon passage.

========

LC004408/SUB A

========

LC004408/SUB A - Page 2 of 2

EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO HEALTH AND SAFETY -- HEALTH CARE ACCESSIBILITY AND

QUALITY ASSURANCE ACT

***

     This act would provide that no contract between an insurance company or similar entity

and a provider of eye care services would require the provider to provide services to a subscriber

at a price set by the insurer, unless the services were covered under the applicable insurance

agreement.

     This act would take effect upon passage.

========

LC004408/SUB A

========

LC004408/SUB A - Page 3 of 2