2014 -- S 2873

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LC005309

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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 -- NONPROFIT MEDICAL SERVICE CORPORATIONS

     Introduced By: Senator James E.Doyle

     Date Introduced: April 09, 2014

     Referred To: Senate Health & Human Services

     It is enacted by the General Assembly as follows:

     SECTION 1. Section 27-20-35 of the General Laws in Chapter 27-20 entitled "Nonprofit

Medical Service Corporations" is hereby amended to read as follows:

     27-20-35. Third party reimbursement for services of certain health care workers. --

(a) Every individual or group health insurance contract, plan or policy delivered, issued or

renewed by an insurer or nonprofit or for profit health service corporation which provides

benefits to individual subscribers and members within the state, or to all group members having a

principal place of employment within the state, shall provide benefits for services rendered by a

certified registered nurse anesthetist designated as a certified registered nurse anesthetist by the

board of nurse registration and nursing education; provided, that the following conditions are met:

      (1) The certified registered nurse anesthetist provides certain health care services under

the supervision of anesthesiologists, licensed physicians or licensed dentists in accordance with

section 5-34.2-2(c), which requires substantial specialized knowledge, judgment and skill related

to the administration of anesthesia, including pre-operative and post-operative assessment of

patients; administering anesthetics; monitoring patients during anesthesia; management of fluids

in intravenous therapy and management of respiratory care; The certified registered nurse

anesthetist (CRNA) provides certain health care services in collaboration with anesthesiologists,

licensed physicians, or licensed dentists in accordance with § 5-31-1(16) which requires

substantial specialized knowledge, judgment and skill related to the administration of anesthesia,

including preoperative and postoperative assessment of patients; administering anesthetics;

monitoring patients during anesthesia; management of fluid in intravenous therapy and

management of respiratory care. It also includes, in connection with the immediate perioperative

care of a patient, the ability to issue a medication order for drugs or medications to be

administered by a licensed, certified, or registered health care provider; to order and evaluate

laboratory and diagnostic test results and perform point-of-care testing that the CRNA is qualified

to perform; and order and evaluate radiographic imaging studies that the CRNA is qualified to

order and interpret. For the purposes of this section, the immediate perioperative care of a patient

shall be defined as the period commencing on the day prior to surgery and ending upon discharge

of the patient from post-anesthesia care.

      (2) The policy or contract currently provides benefits for identical services rendered by a

provider of health care licensed by the state; and

      (3) The certified registered nurse anesthetist is not a salaried employee of the licensed

hospital or facility for which the nonprofit medical service corporation has an alternative

contractual relationship to fund the services of a certified registered nurse anesthetist.

      (b) It shall remain within the sole discretion of the nonprofit medical service corporation

as to which certified registered nurse anesthetists it shall contract with. Reimbursement shall be

provided according to the respective principles and policies of the nonprofit medical service

corporation; provided, that no nonprofit medical service corporation may be required to pay for

duplicative services actually rendered by a certified registered nurse anesthetist and any other

health care provider. Nothing contained in this section shall preclude the nonprofit medical

service corporation from conducting managed care, medical necessity or utilization review.

     (c) Providers. – A group health plan and a health insurance issuer offering group or

individual health insurance coverage shall not discriminate with respect to participation under the

plan or coverage against any health care provider who is acting within the scope of that provider's

license or certification under applicable state law. This section shall not require that a group

health plan or health insurance issuer contract with any health care provider willing to abide by

the terms and conditions for participation established by the plan or issuer. Nothing in this section

shall be construed as preventing a group health plan, or a health insurance issuer, establishing

varying reimbursement rates based on quality or performance measures.

     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 INSURANCE -- NONPROFIT MEDICAL SERVICE CORPORATIONS

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     This act would require health insurance contracts to provide preoperative and

perioperative benefits for services rendered by a certified registered nurse anesthetist, including

but not limited to, administration of anesthetics; evaluation of test results; and issuance of

medication orders.

     This act would also prohibit a group health plan and a health insurance issuer from

discriminating with respect to participation under the plan or coverage against any health provider

who is acting within the scope of that provider's license or certification under applicable law.

     This act would take effect upon passage.

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LC005309

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