H5702

	2015 -- H 5702
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	LC001561
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	STATE OF RHODE ISLAND
	IN GENERAL ASSEMBLY
	JANUARY SESSION, A.D. 2015
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	A N A C T
	RELATING TO INSURANCE - ACCIDENT AND SICKNESS INSURANCE POLICIES

	Introduced By: Representative Raymond H. Johnston
	Date Introduced: February 26, 2015
	Referred To: House Corporations
	It is enacted by the General Assembly as follows:
1	SECTION 1. Chapter 27-18 of the General Laws entitled "Accident and Sickness
2	Insurance Policies" is hereby amended by adding thereto the following section:
3	27-18-34.1. Health insurance contracts - Clinical pharmacist practitioners. – (a)
4	Every health insurance contract, plan, or policy delivered, issued for delivery, or renewed in this
5	state shall provide coverage for the services of a clinical pharmacist practitioner, practicing
6	collaboratively, or in the employ of a pharmacist licensed under chapter 19.1 of title 5, to
7	subscribers if the services are within the clinical pharmacist practitioner's area of professional
8	competence as established by education and certification, and are currently reimbursed when
9	rendered by any other licensed health care provider. No insurer or hospital, medical service
10	corporation, or health maintenance organization may require the signature, by any other health
11	care provider as a condition of reimbursement. No insurer or hospital, medical service
12	corporation, or health maintenance organization may be required to pay for duplicative services
13	actually rendered by both a clinical pharmacist practitioner and any other health care provider.
14	(b) Nothing in this chapter shall preclude the conducting of managed care reviews and
15	medical necessity reviews by an insurer or hospital, medical service corporation or health
16	maintenance organization.
17	(c) Every health insurance contract, plan, or policy delivered, issued for delivery, or
18	renewed in this state shall provide coverage for clinical pharmacist practitioners to provide
19	primary care, intermediate, home, long-term and inpatient care as primary care providers, when

1	said clinical pharmacist practitioner is a participating provider, consistent with, and practicing
2	within, the scope of his/her professional license.
3	(d) Notwithstanding any law to the contrary, all insurers, nonprofit medical service
4	corporations, nonprofit hospital service corporations and health maintenance organizations shall
5	provide subscribers with an opportunity to select a clinical pharmacist practitioner, who is a
6	participating provider, as a primary care provider.
7	(e) Notwithstanding any law to the contrary, all insurers, nonprofit medical service
8	corporations, nonprofit hospital service corporations and health maintenance organizations shall
9	insure that all participating primary care provider clinical pharmacist practitioners are included on
10	any publicly accessible list of participating providers for the respective organization.
11	(f) This section shall not apply to insurance coverage providing benefits for; (1) Hospital
12	confinement indemnity; (2) Disability income: (3) Accident only; (4) Long-term care; (5)
13	Medicare supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or
14	bodily injury or death by accident or both; and (9) Other limited benefit policies.
15	SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service
16	Corporations" is hereby amended by adding thereto the following section:
17	27-19-27.1. Health insurance contracts - Clinical pharmacist practitioners. -- (a)
18	Every health insurance contract, plan, or policy delivered, issued for delivery, or renewed in this
19	state shall provide coverage for the services of a clinical pharmacist practitioner, practicing
20	collaboratively, or in the employ of a pharmacist licensed under chapter 19.1 of title 5, to
21	subscribers if the services are within the clinical pharmacist practitioner's area of professional
22	competence as established by education and certification, and are currently reimbursed when
23	rendered by any other licensed health care provider. No insurer or hospital, medical service
24	corporation, or health maintenance organization may require the signature, by any other health
25	care provider as a condition of reimbursement. No insurer or hospital, medical service
26	corporation, or health maintenance organization may be required to pay for duplicative services
27	actually rendered by both a clinical pharmacist practitioner and any other health care provider.
28	(b) Nothing in this chapter shall preclude the conducting of managed care reviews and
29	medical necessity reviews by an insurer or hospital, medical service corporation or health
30	maintenance organization.
31	(c) Every health insurance contract, plan, or policy delivered, issued for delivery, or
32	renewed in this state shall provide coverage for clinical pharmacist practitioners to provide
33	primary care, intermediate, home, long-term and inpatient care as primary care providers, when
34	said clinical pharmacist practitioner is a participating provider, consistent with, and practicing
	LC001561 - Page 2 of 7
1	within, the scope of his/her professional license.
2	(d) Notwithstanding any law to the contrary, all insurers, nonprofit medical service
3	corporations, nonprofit hospital service corporations and health maintenance organizations shall
4	provide subscribers with an opportunity to select a clinical pharmacist practitioner, who is a
5	participating provider, as a primary care provider.
6	(e) Notwithstanding any law to the contrary, all insurers, nonprofit medical service
7	corporations, nonprofit hospital service corporations and health maintenance organizations shall
8	insure that all participating primary care provider clinical pharmacist practitioners are included on
9	any publicly accessible list of participating providers for the respective organization.
10	(f) This section shall not apply to insurance coverage providing benefits for; (1) Hospital
11	confinement indemnity; (2) Disability income: (3) Accident only; (4) Long-term care; (5)
12	Medicare supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or
13	bodily injury or death by accident or both; and (9) Other limited benefit policies.
14	SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service
15	Corporations" is hereby amended by adding thereto the following section:
16	27-20-35.2. Third-party reimbursement for services of clinical pharmacist
17	practitioners. -- (a) Every health insurance contract, plan, or policy delivered, issued for
18	delivery, or renewed in this state shall provide coverage for the services of a clinical pharmacist
19	practitioner, practicing collaboratively, or in the employ of a pharmacist licensed under chapter
20	19.1 of title 5, to subscribers if the services are within the clinical pharmacist practitioner's area of
21	professional competence as established by education and certification, and are currently
22	reimbursed when rendered by any other licensed health care provider. No insurer or hospital,
23	medical service corporation, or health maintenance organization may require the signature, by
24	any other health care provider as a condition of reimbursement. No insurer or hospital, medical
25	service corporation, or health maintenance organization may be required to pay for duplicative
26	services actually rendered by both a clinical pharmacist practitioner and any other health care
27	provider.
28	(b) Nothing in this chapter shall preclude the conducting of managed care reviews and
29	medical necessity reviews by an insurer or hospital, medical service corporation or health
30	maintenance organization.
31	(c) Every health insurance contract, plan, or policy delivered, issued for delivery, or
32	renewed in this state shall provide coverage for clinical pharmacist practitioners to provide
33	primary care, intermediate, home, long-term and inpatient care as primary care providers, when
34	said clinical pharmacist practitioner is a participating provider, consistent with, and practicing
	LC001561 - Page 3 of 7
1	within, the scope of his/her professional license.
2	(d) Notwithstanding any law to the contrary, all insurers, nonprofit medical service
3	corporations, nonprofit hospital service corporations and health maintenance organizations shall
4	provide subscribers with an opportunity to select a clinical pharmacist practitioner, who is a
5	participating provider, as a primary care provider.
6	(e) Notwithstanding any law to the contrary, all insurers, nonprofit medical service
7	corporations, nonprofit hospital service corporations and health maintenance organizations shall
8	insure that all participating primary care provider clinical pharmacist practitioners are included on
9	any publicly accessible list of participating providers for the respective organization.
10	(f) This section shall not apply to insurance coverage providing benefits for; (1) Hospital
11	confinement indemnity; (2) Disability income: (3) Accident only; (4) Long-term care; (5)
12	Medicare supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or
13	bodily injury or death by accident or both; and (9) Other limited benefit policies.
14	SECTION 4. Chapter 27-20.1 of the General Laws entitled "Nonprofit Dental Service
15	Corporations" is hereby amended by adding thereto the following section:
16	27-20.1-9.1. Health insurance contracts - Clinical pharmacist practitioners. -- (a)
17	Every health insurance contract, plan, or policy delivered, issued for delivery, or renewed in this
18	state shall provide coverage for the services of a clinical pharmacist practitioner, practicing
19	collaboratively, or in the employ of a pharmacist licensed under chapter 19.1 of title 5, to
20	subscribers if the services are within the clinical pharmacist practitioner's area of professional
21	competence as established by education and certification, and are currently reimbursed when
22	rendered by any other licensed health care provider. No insurer or hospital, medical service
23	corporation, or health maintenance organization may require the signature, by any other health
24	care provider as a condition of reimbursement. No insurer or hospital, medical service
25	corporation, or health maintenance organization may be required to pay for duplicative services
26	actually rendered by both a clinical pharmacist practitioner and any other health care provider.
27	(b) Nothing in this chapter shall preclude the conducting of managed care reviews and
28	medical necessity reviews by an insurer or hospital, medical service corporation or health
29	maintenance organization.
30	(c) Every health insurance contract, plan, or policy delivered, issued for delivery, or
31	renewed in this state shall provide coverage for clinical pharmacist practitioners to provide
32	primary care, intermediate, home, long-term and inpatient care as primary care providers, when
33	said clinical pharmacist practitioner is a participating provider, consistent with, and practicing
34	within, the scope of his/her professional license.
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1	(d) Notwithstanding any law to the contrary, all insurers, nonprofit medical service
2	corporations, nonprofit hospital service corporations and health maintenance organizations shall
3	provide subscribers with an opportunity to select a clinical pharmacist practitioner, who is a
4	participating provider, as a primary care provider.
5	(e) Notwithstanding any law to the contrary, all insurers, nonprofit medical service
6	corporations, nonprofit hospital service corporations and health maintenance organizations shall
7	insure that all participating primary care provider clinical pharmacist practitioners are included on
8	any publicly accessible list of participating providers for the respective organization.
9	(f) This section shall not apply to insurance coverage providing benefits for; (1) Hospital
10	confinement indemnity; (2) Disability income: (3) Accident only; (4) Long-term care; (5)
11	Medicare supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or
12	bodily injury or death by accident or both; and (9) Other limited benefit policies.
13	SECTION 5. Chapter 27-41 of the General Laws entitled "Health Maintenance
14	Organizations" is hereby amended by adding thereto the following section:
15	27-41-40.1. Health insurance contracts - Clinical pharmacist practitioners. -- (a)
16	Every health insurance contract, plan, or policy delivered, issued for delivery, or renewed in this
17	state shall provide coverage for the services of a clinical pharmacist practitioner, practicing
18	collaboratively, or in the employ of a pharmacist licensed under chapter 19.1 of title 5, to
19	subscribers if the services are within the clinical pharmacist practitioner's area of professional
20	competence as established by education and certification, and are currently reimbursed when
21	rendered by any other licensed health care provider. No insurer or hospital, medical service
22	corporation, or health maintenance organization may require the signature, by any other health
23	care provider as a condition of reimbursement. No insurer or hospital, medical service
24	corporation, or health maintenance organization may be required to pay for duplicative services
25	actually rendered by both a clinical pharmacist practitioner and any other health care provider.
26	(b) Nothing in this chapter shall preclude the conducting of managed care reviews and
27	medical necessity reviews by an insurer or hospital, medical service corporation or health
28	maintenance organization.
29	(c) Every health insurance contract, plan, or policy delivered, issued for delivery, or
30	renewed in this state shall provide coverage for clinical pharmacist practitioners to provide
31	primary care, intermediate, home, long-term and inpatient care as primary care providers, when
32	said clinical pharmacist practitioner is a participating provider, consistent with, and practicing
33	within, the scope of his/her professional license.
34	(d) Notwithstanding any law to the contrary, all insurers, nonprofit medical service
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1	corporations, nonprofit hospital service corporations and health maintenance organizations shall
2	provide subscribers with an opportunity to select a clinical pharmacist practitioner, who is a
3	participating provider, as a primary care provider.
4	(e) Notwithstanding any law to the contrary, all insurers, nonprofit medical service
5	corporations, nonprofit hospital service corporations and health maintenance organizations shall
6	insure that all participating primary care provider clinical pharmacist practitioners are included on
7	any publicly accessible list of participating providers for the respective organization.
8	(f) This section shall not apply to insurance coverage providing benefits for; (1) Hospital
9	confinement indemnity; (2) Disability income: (3) Accident only; (4) Long-term care; (5)
10	Medicare supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or
11	bodily injury or death by accident or both; and (9) Other limited benefit policies.
12	SECTION 6. This act shall take effect upon passage.
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	LC001561
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	EXPLANATION
	BY THE LEGISLATIVE COUNCIL
	OF
	A N A C T
	RELATING TO INSURANCE - ACCIDENT AND SICKNESS INSURANCE POLICIES
	***
1	This act would require all health insurance contracts, plans, or policies to provide
2	coverage for the services of clinical pharmacist practitioners.
3	This act would take effect upon passage.
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	LC001561
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