S0421

	2015 -- S 0421
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	LC001241
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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: Senators Doyle, P Fogarty, Nesselbush, and Lynch
	Date Introduced: February 25, 2015
	Referred To: Senate Health & Human Services
	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) This section shall not apply to insurance coverage providing benefits for; (1) Hospital
18	confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care; (5)
19	Medicare supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or

1	bodily injury or death by accident or both; and (9) Other limited benefit policies.
2	SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service
3	Corporations" is hereby amended by adding thereto the following section:
4	27-19-27.1. Health insurance contracts - Clinical pharmacist practitioners. -- (a)
5	Every health insurance contract, plan, or policy delivered, issued for delivery, or renewed in this
6	state shall provide coverage for the services of a clinical pharmacist practitioner, practicing
7	collaboratively, or in the employ of a pharmacist licensed under chapter 19.1 of title 5, to
8	subscribers if the services are within the clinical pharmacist practitioner's area of professional
9	competence as established by education and certification, and are currently reimbursed when
10	rendered by any other licensed health care provider. No insurer or hospital, medical service
11	corporation, or health maintenance organization may require the signature, by any other health
12	care provider as a condition of reimbursement. No insurer or hospital, medical service
13	corporation, or health maintenance organization may be required to pay for duplicative services
14	actually rendered by both a clinical pharmacist practitioner and any other health care provider.
15	(b) Nothing in this chapter shall preclude the conducting of managed care reviews and
16	medical necessity reviews by an insurer or hospital, medical service corporation or health
17	maintenance organization.
18	(c) This section shall not apply to insurance coverage providing benefits for; (1) Hospital
19	confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care; (5)
20	Medicare supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or
21	bodily injury or death by accident or both; and (9) Other limited benefit policies.
22	SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service
23	Corporations" is hereby amended by adding thereto the following section:
24	27-20-35.2. Third-party reimbursement for services of clinical pharmacist
25	practitioners. -- (a) Every health insurance contract, plan, or policy delivered, issued for
26	delivery, or renewed in this state shall provide coverage for the services of a clinical pharmacist
27	practitioner, practicing collaboratively, or in the employ of a pharmacist licensed under chapter
28	19.1 of title 5, to subscribers if the services are within the clinical pharmacist practitioner's area of
29	professional competence as established by education and certification, and are currently
30	reimbursed when rendered by any other licensed health care provider. No insurer or hospital,
31	medical service corporation, or health maintenance organization may require the signature, by
32	any other health care provider as a condition of reimbursement. No insurer or hospital, medical
33	service corporation, or health maintenance organization may be required to pay for duplicative
34	services actually rendered by both a clinical pharmacist practitioner and any other health care
	LC001241 - Page 2 of 5
1	provider.
2	(b) Nothing in this chapter shall preclude the conducting of managed care reviews and
3	medical necessity reviews by an insurer or hospital, medical service corporation or health
4	maintenance organization.
5	(c) This section shall not apply to insurance coverage providing benefits for; (1) Hospital
6	confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care; (5)
7	Medicare supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or
8	bodily injury or death by accident or both; and (9) Other limited benefit policies.
9	SECTION 4. Chapter 27-20.1 of the General Laws entitled "Nonprofit Dental Service
10	Corporations" is hereby amended by adding thereto the following section:
11	27-20.1-9.1. Health insurance contracts - Clinical pharmacist practitioners. -- (a)
12	Every health insurance contract, plan, or policy delivered, issued for delivery, or renewed in this
13	state shall provide coverage for the services of a clinical pharmacist practitioner, practicing
14	collaboratively, or in the employ of a pharmacist licensed under chapter 19.1 of title 5, to
15	subscribers if the services are within the clinical pharmacist practitioner's area of professional
16	competence as established by education and certification, and are currently reimbursed when
17	rendered by any other licensed health care provider. No insurer or hospital, medical service
18	corporation, or health maintenance organization may require the signature, by any other health
19	care provider as a condition of reimbursement. No insurer or hospital, medical service
20	corporation, or health maintenance organization may be required to pay for duplicative services
21	actually rendered by both a clinical pharmacist practitioner and any other health care provider.
22	(b) Nothing in this chapter shall preclude the conducting of managed care reviews and
23	medical necessity reviews by an insurer or hospital, medical service corporation or health
24	maintenance organization.
25	(c) This section shall not apply to insurance coverage providing benefits for; (1) Hospital
26	confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care; (5)
27	Medicare supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or
28	bodily injury or death by accident or both; and (9) Other limited benefit policies.
29	SECTION 5. Chapter 27-41 of the General Laws entitled "Health Maintenance
30	Organizations" is hereby amended by adding thereto the following section:
31	27-41-40.1. Health insurance contracts - Clinical pharmacist practitioners. -- (a)
32	Every health insurance contract, plan, or policy delivered, issued for delivery, or renewed in this
33	state shall provide coverage for the services of a clinical pharmacist practitioner, practicing
34	collaboratively, or in the employ of a pharmacist licensed under chapter 19.1 of title 5, to
	LC001241 - Page 3 of 5
1	subscribers if the services are within the clinical pharmacist practitioner's area of professional
2	competence as established by education and certification, and are currently reimbursed when
3	rendered by any other licensed health care provider. No insurer or hospital, medical service
4	corporation, or health maintenance organization may require the signature, by any other health
5	care provider as a condition of reimbursement. No insurer or hospital, medical service
6	corporation, or health maintenance organization may be required to pay for duplicative services
7	actually rendered by both a clinical pharmacist practitioner and any other health care provider.
8	(b) Nothing in this chapter shall preclude the conducting of managed care reviews and
9	medical necessity reviews by an insurer or hospital, medical service corporation or health
10	maintenance organization.
11	(c) 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 6. 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 - ACCIDENT AND SICKNESS INSURANCE POLICIES
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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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	LC001241
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