S0421A

	2015 -- S 0421 SUBSTITUTE A
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	LC001241/SUB A
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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 – Pharmacists. – (a) Every health insurance
4	contract, plan, or policy delivered, issued for delivery, or renewed in this state shall provide
5	coverage for the services of a pharmacist practicing collaboratively, or in the employ of a
6	pharmacist or pharmacy licensed under chapter 19.1 of title 5, to subscribers if the services are
7	within the pharmacist's area of professional competence as established by education and
8	certification, and are currently reimbursed when rendered by any other licensed health care
9	provider. No insurer or hospital, medical service corporation, or health maintenance organization
10	may require the signature, by any other health care provider as a condition of reimbursement. No
11	insurer or hospital, medical service corporation, or health maintenance organization may be
12	required to pay for duplicative services actually rendered by both a pharmacist and any other
13	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 - Pharmacists. -- (a) Every health insurance
5	contract, plan, or policy delivered, issued for delivery, or renewed in this state shall provide
6	coverage for the services of a pharmacist practicing collaboratively, or in the employ of a
7	pharmacist or pharmacy licensed under chapter 19.1 of title 5, to subscribers if the services are
8	within the pharmacist's area of professional competence as established by education and
9	certification, and are currently reimbursed when rendered by any other licensed health care
10	provider. No insurer or hospital, medical service corporation, or health maintenance organization
11	may require the signature, by any other health care provider as a condition of reimbursement. No
12	insurer or hospital, medical service corporation, or health maintenance organization may be
13	required to pay for duplicative services actually rendered by both a pharmacist and any other
14	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 Pharmacist's. -- (a) Every
25	health insurance contract, plan, or policy delivered, issued for delivery, or renewed in this state
26	shall provide coverage for the services of a pharmacist, practicing collaboratively, or in the
27	employ of a pharmacist or pharmacy licensed under chapter 19.1 of title 5, to subscribers if the
28	services are within the pharmacist's area of professional competence as established by education
29	and certification, and are currently reimbursed when rendered by any other licensed health care
30	provider. No insurer or hospital, medical service corporation, or health maintenance organization
31	may require the signature, by any other health care provider as a condition of reimbursement. No
32	insurer or hospital, medical service corporation, or health maintenance organization may be
33	required to pay for duplicative services actually rendered by both a pharmacist and any other
34	health care provider.
	LC001241/SUB A - Page 2 of 4
1	(b) Nothing in this chapter shall preclude the conducting of managed care reviews and
2	medical necessity reviews by an insurer or hospital, medical service corporation or health
3	maintenance organization.
4	(c) This section shall not apply to insurance coverage providing benefits for: (1) Hospital
5	confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care; (5)
6	Medicare supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or
7	bodily injury or death by accident or both; and (9) Other limited benefit policies.
8	SECTION 4. Chapter 27-20.1 of the General Laws entitled "Nonprofit Dental Service
9	Corporations" is hereby amended by adding thereto the following section:
10	27-20.1-9.1. Health insurance contracts – Pharmacists. -- (a) Every health insurance
11	contract, plan, or policy delivered, issued for delivery, or renewed in this state shall provide
12	coverage for the services of a pharmacist, practicing collaboratively, or in the employ of a
13	pharmacist or pharmacy licensed under chapter 19.1 of title 5, to subscribers if the services are
14	within the pharmacist's area of professional competence as established by education and
15	certification, and are currently reimbursed when rendered by any other licensed health care
16	provider. No insurer or hospital, medical service corporation, or health maintenance organization
17	may require the signature, by any other health care provider as a condition of reimbursement. No
18	insurer or hospital, medical service corporation, or health maintenance organization may be
19	required to pay for duplicative services actually rendered by both a pharmacist and any other
20	health care provider.
21	(b) Nothing in this chapter shall preclude the conducting of managed care reviews and
22	medical necessity reviews by an insurer or hospital, medical service corporation or health
23	maintenance organization.
24	(c) This section shall not apply to insurance coverage providing benefits for: (1) Hospital
25	confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care; (5)
26	Medicare supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or
27	bodily injury or death by accident or both; and (9) Other limited benefit policies.
28	SECTION 5. Chapter 27-41 of the General Laws entitled "Health Maintenance
29	Organizations" is hereby amended by adding thereto the following section:
30	27-41-40.1. Health insurance contracts - Pharmacists. -- (a) Every health insurance
31	contract, plan, or policy delivered, issued for delivery, or renewed in this state shall provide
32	coverage for the services of a pharmacist, practicing collaboratively, or in the employ of a
33	pharmacist or pharmacy licensed under chapter 19.1 of title 5, to subscribers if the services are
34	within the pharmacist's area of professional competence as established by education and
	LC001241/SUB A - Page 3 of 4
1	certification, and are currently reimbursed when rendered by any other licensed health care
2	provider. No insurer or hospital, medical service corporation, or health maintenance organization
3	may require the signature, by any other health care provider as a condition of reimbursement. No
4	insurer or hospital, medical service corporation, or health maintenance organization may be
5	required to pay for duplicative services actually rendered by both a pharmacist and any other
6	health care provider.
7	(b) Nothing in this chapter shall preclude the conducting of managed care reviews and
8	medical necessity reviews by an insurer or hospital, medical service corporation or health
9	maintenance organization.
10	(c) 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 6. This act shall take effect upon passage.
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	LC001241/SUB A
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	LC001241/SUB A - Page 4 of 4
	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 pharmacists.
3	This act would take effect upon passage.
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	LC001241/SUB A
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	LC001241/SUB A - Page 5 of 4