2014 -- S 2878

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LC005310

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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 MAINTENANCE ORGANIZATIONS

     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 27-41-49 of the General Laws in Chapter 27-41 entitled "Health

Maintenance Organizations" is hereby amended to read as follows:

     27-41-49. 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, health maintenance organization, 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 provides certain health care services in collaboration with anesthesiologists, licensed

physicians, or licensed dentists 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 preoperative 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 preoperative 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 health maintenance organization 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 health maintenance organization as to

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

provided according to the respective principles and policies of the health maintenance

organization; provided, that no health maintenance organization 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 health maintenance

organization from conducting managed care, medical necessity or utilization review.

     (c) 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 - HEALTH MAINTENANCE ORGANIZATIONS

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

discriminating 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 act would take effect upon passage.

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LC005310

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