S2878A

	2014 -- S 2878 SUBSTITUTE A
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	LC005310/SUB A/2
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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:
1	SECTION 1. Section 27-18-48 of the General Laws in Chapter 27-18 entitled "Accident
2	and Sickness Insurance Policies" is hereby amended to read as follows:
3	27-18-48. Third party reimbursement for services of certain health care workers. --
4	(a) Every individual or group hospital or medical services plan contract delivered, issued or
5	renewed by an insurer or nonprofit or for profit health service corporation which provides
6	benefits to individual subscribers and members within the state, or to all group members having a
7	principal place of employment within the state, shall provide benefits for services rendered by a
8	certified registered nurse anesthetist designated as a certified registered nurse anesthetist by the
9	board of nurse registration and nursing education; provided, that the following conditions are met:
10	(1) The certified registered nurse anesthetist provides certain health care services under
11	the supervision of anesthesiologists, licensed physicians or licensed dentists in accordance with
12	section 5-34.2-2(c), which requires substantial specialized knowledge, judgment and skill related
13	to the administration of anesthesia, including pre-operative and post-operative assessment of
14	patients; administering anesthetics; monitoring patients during anesthesia; management of fluids
15	in intravenous therapy and management of respiratory care; The certified registered nurse
16	anesthetist adheres to the practice of certified registered nurse anesthesia as defined by and in
17	accordance with § 5-34.2-2.
18	(2) The policy or contract currently provides benefits for identical services rendered by a
19	provider of health care licensed by the state; and

1	(3) The certified registered nurse anesthetist is not a salaried employee of the licensed
2	hospital or facility for which the accident and sickness insurer has an alternative contractual
3	relationship to fund the services of a certified registered nurse anesthetist.
4	(b) It shall remain within the sole discretion of the health maintenance organization as to
5	which certified registered nurse anesthetists it shall contract with. Reimbursement shall be
6	provided according to the respective principles and policies of the health maintenance
7	organization; provided, that no health maintenance organization may be required to pay for
8	duplicative services actually rendered by a certified registered nurse anesthetist and any other
9	health care provider. Nothing contained in this section shall preclude the health maintenance
10	organization from conducting managed care, medical necessity or utilization review.
11	(c) Providers. -- A group health plan and a health insurance issuer offering group or
12	individual health insurance coverage shall not discriminate with respect to participation under the
13	plan or coverage against any health care provider who is acting within the scope of that provider's
14	license or certification under applicable state law. This section shall not require that a group
15	health plan or health insurance issuer contract with any health care provider willing to abide by
16	the terms and conditions for participation established by the plan or issuer. Nothing in this section
17	shall be construed as preventing a group health plan, or a health insurance issuer, from
18	establishing varying reimbursement rates based on quality or performance measures.
19	SECTION 2. Section 27-19-40 of the General Laws in Chapter 27-19 entitled "Nonprofit
20	Hospital Service Corporations" is hereby amended to read as follows:
21	27-19-40. Third party reimbursement for services of certain health care workers. --
22	(a) Every individual or group health insurance contract, plan or policy delivered, issued or
23	renewed by an insurer or nonprofit or for profit health service corporation which provides
24	benefits to individual subscribers and members within the state, or to all group members having a
25	principal place of employment within the state, shall provide benefits for services rendered by a
26	certified registered nurse anesthetist designated as a certified registered nurse anesthetist by the
27	board of nurse registration and nursing education; provided, that the following conditions are met:
28	(1) The certified registered nurse anesthetist provides certain health care services under
29	the supervision of anesthesiologists, licensed physicians or licensed dentists in accordance with
30	section 5-34.2-2(c), which requires substantial specialized knowledge, judgment and skill related
31	to the administration of anesthesia, including pre-operative and post-operative assessment of
32	patients; administering anesthetics, monitoring patients during anesthesia; management of fluids
33	in intravenous therapy and management of respiratory care; adheres to the practice of certified
34	registered nurse anesthesia as defined by and in accordance with § 5-34.2-2.
	LC005310/SUB A/2 - Page 2 of 5
1	(2) The policy or contract currently provides benefits for identical services rendered by a
2	provider of health care licensed by the state; and
3	(3) The certified registered nurse anesthetist is not a salaried employee of the licensed
4	hospital or facility for which the nonprofit hospital service corporation has an alternative
5	contractual relationship to fund the services of a certified registered nurse anesthetist.
6	(b) It shall remain within the sole discretion of the nonprofit hospital service corporation
7	as to which certified registered nurse anesthetists it shall contract with. Reimbursement shall be
8	provided according to the respective principles and policies of the nonprofit hospital service
9	corporation; provided, that no nonprofit hospital service corporation may be required to pay for
10	duplicative services actually rendered by a certified registered nurse anesthetist and any other
11	health care provider. Nothing contained in this section shall preclude the nonprofit hospital
12	service corporation from conducting managed care, medical necessity or utilization review.
13	(c) Providers. -- A group health plan and a health insurance issuer offering group or
14	individual health insurance coverage shall not discriminate with respect to participation under the
15	plan or coverage against any health care provider who is acting within the scope of that provider's
16	license or certification under applicable state law. This section shall not require that a group
17	health plan or health insurance issuer contract with any health care provider willing to abide by
18	the terms and conditions for participation established by the plan or issuer. Nothing in this section
19	shall be construed as preventing a group health plan, or a health insurance issuer, from
20	establishing varying reimbursement rates based on quality or performance measures.
21	SECTION 3. Section 27-20-35 of the General Laws in Chapter 27-20 entitled "Nonprofit
22	Medical Service Corporations" is hereby amended to read as follows:
23	27-20-35. Third party reimbursement for services of certain health care workers. --
24	(a) Every individual or group health insurance contract, plan or policy delivered, issued or
25	renewed by an insurer or nonprofit or for profit health service corporation which provides
26	benefits to individual subscribers and members within the state, or to all group members having a
27	principal place of employment within the state, shall provide benefits for services rendered by a
28	certified registered nurse anesthetist designated as a certified registered nurse anesthetist by the
29	board of nurse registration and nursing education; provided, that the following conditions are met:
30	(1) The certified registered nurse anesthetist provides certain health care services under
31	the supervision of anesthesiologists, licensed physicians or licensed dentists in accordance with
32	section 5-34.2-2(c), which requires substantial specialized knowledge, judgment and skill related
33	to the administration of anesthesia, including pre-operative and post-operative assessment of
34	patients; administering anesthetics; monitoring patients during anesthesia; management of fluids
	LC005310/SUB A/2 - Page 3 of 5
1	in intravenous therapy and management of respiratory care; adheres to the practice of certified
2	registered nurse anesthesia as defined by and in accordance with § 5-34.2-2.
3	(2) The policy or contract currently provides benefits for identical services rendered by a
4	provider of health care licensed by the state; and
5	(3) The certified registered nurse anesthetist is not a salaried employee of the licensed
6	hospital or facility for which the nonprofit medical service corporation has an alternative
7	contractual relationship to fund the services of a certified registered nurse anesthetist.
8	(b) It shall remain within the sole discretion of the nonprofit medical service corporation
9	as to which certified registered nurse anesthetists it shall contract with. Reimbursement shall be
10	provided according to the respective principles and policies of the nonprofit medical service
11	corporation; provided, that no nonprofit medical service corporation may be required to pay for
12	duplicative services actually rendered by a certified registered nurse anesthetist and any other
13	health care provider. Nothing contained in this section shall preclude the nonprofit medical
14	service corporation from conducting managed care, medical necessity or utilization review.
15	(c) Providers. -- A group health plan and a health insurance issuer offering group or
16	individual health insurance coverage shall not discriminate with respect to participation under the
17	plan or coverage against any health care provider who is acting within the scope of that provider's
18	license or certification under applicable state law. This section shall not require that a group
19	health plan or health insurance issuer contract with any health care provider willing to abide by
20	the terms and conditions for participation established by the plan or issuer. Nothing in this section
21	shall be construed as preventing a group health plan, or a health insurance issuer, from
22	establishing varying reimbursement rates based on quality or performance measures.
23	SECTION 4. Section 27-41-49 of the General Laws in Chapter 27-41 entitled "Health
24	Maintenance Organizations" is hereby amended to read as follows:
25	27-41-49. Third party reimbursement for services of certain health care workers. --
26	(a) Every individual or group health insurance contract, plan or policy delivered, issued or
27	renewed by an insurer, health maintenance organization, nonprofit or for profit health service
28	corporation which provides benefits to individual subscribers and members within the state, or to
29	all group members having a principal place of employment within the state, shall provide benefits
30	for services rendered by a certified registered nurse anesthetist designated as a certified registered
31	nurse anesthetist by the board of nurse registration and nursing education; provided, that the
32	following conditions are met:
33	(1) The certified registered nurse anesthetist provides certain health care services under
34	the supervision of anesthesiologists, licensed physicians or licensed dentists in accordance with
	LC005310/SUB A/2 - Page 4 of 5
1	section 5-34.2-2(c), which requires substantial specialized knowledge, judgment and skill related
2	to the administration of anesthesia, including pre-operative and post-operative assessment of
3	patients; administering anesthetics; monitoring patients during anesthesia; management of fluids
4	in intravenous therapy and management of respiratory care; adheres to the practice of certified
5	registered nurse anesthesia as defined by and in accordance with § 5-34.2-2.
6	(2) The policy or contract currently provides benefits for identical services rendered by a
7	provider of health care licensed by the state; and
8	(3) The certified registered nurse anesthetist is not a salaried employee of the licensed
9	hospital or facility for which the health maintenance organization has an alternative contractual
10	relationship to fund the services of a certified registered nurse anesthetist.
11	(b) It shall remain within the sole discretion of the health maintenance organization as to
12	which certified registered nurse anesthetists it shall contract with. Reimbursement shall be
13	provided according to the respective principles and policies of the health maintenance
14	organization; provided, that no health maintenance organization may be required to pay for
15	duplicative services actually rendered by a certified registered nurse anesthetist and any other
16	health care provider. Nothing contained in this section shall preclude the health maintenance
17	organization from conducting managed care, medical necessity or utilization review.
18	(c) Providers. -- A group health plan and a health insurance issuer offering group or
19	individual health insurance coverage shall not discriminate with respect to participation under the
20	plan or coverage against any health care provider who is acting within the scope of that provider's
21	license or certification under applicable state law. This section shall not require that a group
22	health plan or health insurance issuer contract with any health care provider willing to abide by
23	the terms and conditions for participation established by the plan or issuer. Nothing in this section
24	shall be construed as preventing a group health plan, or a health insurance issuer, from
25	establishing varying reimbursement rates based on quality or performance measures.
26	SECTION 5. This act shall take effect upon passage.
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	LC005310/SUB A/2
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	LC005310/SUB A/2 - Page 5 of 5
	EXPLANATION
	BY THE LEGISLATIVE COUNCIL
	OF
	A N A C T
	RELATING TO INSURANCE - HEALTH MAINTENANCE ORGANIZATIONS
	***
1	This act would prohibit a group health plan and a health insurance issuer from
2	discriminating with respect to participation under the plan or coverage against any health care
3	provider who is acting within the scope of that provider's license or certification under applicable
4	state law.
5	This act would take effect upon passage.
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	LC005310/SUB A/2
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