S2464

	2016 -- S 2464
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	LC004774
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	STATE OF RHODE ISLAND
	IN GENERAL ASSEMBLY
	JANUARY SESSION, A.D. 2016
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	A N A C T
	RELATING TO INSURANCE - HEALTH INSURANCE

	Introduced By: Senator Roger Picard
	Date Introduced: February 11, 2016
	Referred To: Senate Health & Human Services
	It is enacted by the General Assembly as follows:
1	SECTION 1. Section 27-18-55 of the General Laws in Chapter 27-18 entitled "Accident
2	and Sickness Insurance Policies" is hereby amended to read as follows:
3	27-18-55. Acupuncture services. -- Acupuncture and Oriental medicine services. --
4	(a) Every individual or group health insurance contract, plan, or group policy delivered, issued for
5	delivery or renewed in this state which provides medical coverage, and every individual or group
6	policy which provides for treatment of persons for the prevention, cure or correction of any
7	illness or physical or mental condition, shall provide, as an optional rider, coverage for the
8	services, within the scope of practice, of a doctor of acupuncture and Oriental medicine licensed
9	under chapter 37.2 of title 5 as a provider of acupuncture services; provided, that this section shall
10	not apply to insurance coverage providing benefits for: (1) hospital confinement indemnity; (2)
11	disability income; (3) accident only; (4) long term care; (5) Medicare supplement; (6) limited
12	benefit health; (7) specified disease indemnity; (8) sickness or bodily injury or death by accident
13	or both; and (9) other limited benefit policies.
14	(b) For the purposes of this section:
15	(1) "Doctor of acupuncture" means a practitioner licensed under chapter 37.2 of title 5.
16	(2) "Coverage for the services of a doctor of acupuncture as a provider of acupuncture
17	services" means coverage for acupuncture as defined in § 5-37.2-2(1).
18	(c) It shall remain within the sole discretion of the accident and sickness insurer as to
19	which doctor of acupuncture and Oriental medicine it shall contract with. Reimbursement shall be

1	provided according to the respective principles and policies of the accident and sickness insurer;
2	provided, that no accident and sickness insurer may be required to pay for duplicative services
3	actually rendered by a doctor of acupuncture and Oriental medicine and any other health care
4	provider. Nothing contained in this section shall preclude the accident and sickness insurer from
5	conducting managed care, medical necessity or utilization review.
6	(d) Providers. – A group health plan and a health insurance issuer offering group or
7	individual health insurance coverage shall not discriminate with respect to participation under the
8	plan or coverage against any health care provider who is acting within the scope of that provider's
9	license or certification under applicable state law. This section shall not require that a group
10	health plan or health insurance issuer contract with any health care provider willing to abide by
11	the terms and conditions for participation established by the plan or issuer. Nothing in this section
12	shall be construed as preventing a group health plan, or a health insurance issuer, from
13	establishing varying reimbursement rates based on quality or performance measures.
14	SECTION 2. Section 27-19-47 of the General Laws in Chapter 27-19 entitled "Nonprofit
15	Hospital Service Corporations" is hereby amended to read as follows:
16	27-19-47. Acupuncture services. -- Acupuncture and Oriental medicine services. --
17	(a) Every individual or group health insurance contract, plan, or group policy delivered, issued for
18	delivery or renewed in this state which provides medical coverage, and every individual or group
19	policy which provides for treatment of persons for the prevention, cure or correction of any
20	illness or physical or mental condition, shall provide, as an optional rider, coverage for the
21	services, within the scope of practice, of a doctor of acupuncture and Oriental medicine licensed
22	under chapter 37.2 of title 5 as a provider of acupuncture services.
23	(b) For the purposes of this section:
24	(1) "Doctor of acupuncture" means a practitioner licensed under chapter 37.2 of title 5.
25	(2) "Coverage for the services of a doctor of acupuncture as a provider of acupuncture
26	services" means coverage for acupuncture as defined in § 5-37.2-2(1).
27	(c) It remains within the sole discretion of the non-profit hospital service corporation as
28	to which doctor of acupuncture and Oriental medicine it shall contract with. Reimbursement is
29	provided according to the respective principles and policies of the non-profit hospital service
30	corporation; provided, that no non-profit hospital service corporation is required to pay for
31	duplicative services actually rendered by a doctor of acupuncture and Oriental medicine and any
32	other health care provider. Nothing contained in this section precludes the non-profit hospital
33	service corporations from conducting managed care, medical necessity or utilization review.
34	(d) Providers. – A group health plan and a health insurance issuer offering group or
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1	individual health insurance coverage shall not discriminate with respect to participation under the
2	plan or coverage against any health care provider who is acting within the scope of that provider's
3	license or certification under applicable state law. This section shall not require that a group
4	health plan or health insurance issuer contract with any health care provider willing to abide by
5	the terms and conditions for participation established by the plan or issuer. Nothing in this section
6	shall be construed as preventing a group health plan, or a health insurance issuer, from
7	establishing varying reimbursement rates based on quality or performance measures.
8	SECTION 3. Section 27-20-42 of the General Laws in Chapter 27-20 entitled "Nonprofit
9	Medical Service Corporations" is hereby amended to read as follows:
10	27-20-42. Acupuncture services. -- Acupuncture and Oriental medicine services. --
11	(a) Every individual or group health insurance contract, plan, or group policy delivered, issued for
12	delivery or renewed in this state which provides medical coverage, and every individual or group
13	policy which provides for treatment of persons for the prevention, cure or correction of any
14	illness or physical or mental condition shall provide, as an optional rider, coverage for the
15	services, within the scope of practice, of a doctor of acupuncture and Oriental medicine licensed
16	under chapter 37.2 of title 5 as a provider of acupuncture services.
17	(b) For the purposes of this section:
18	(1) "Doctor of acupuncture" means a practitioner licensed under chapter 37.2 of title 5.
19	(2) "Coverage for the services of a doctor of acupuncture as a provider of acupuncture
20	services" means coverage for acupuncture as defined in § 5-37.2-2(1).
21	(c) It remains within the sole discretion of the non-profit medical service corporation as
22	to which doctor of acupuncture and Oriental medicine it contracts with. Reimbursement is
23	provided according to the respective principles and policies of the non-profit medical service
24	corporation; provided, that no non-profit medical service corporation may be required to pay for
25	duplicative services actually rendered by a doctor of acupuncture and Oriental medicine and any
26	other health care provider. Nothing contained in this section precludes non-profit medical service
27	corporations from conducting managed care, medical necessity or utilization review.
28	(d) Providers. – A group health plan and a health insurance issuer offering group or
29	individual health insurance coverage shall not discriminate with respect to participation under the
30	plan or coverage against any health care provider who is acting within the scope of that provider's
31	license or certification under applicable state law. This section shall not require that a group
32	health plan or health insurance issuer contract with any health care provider willing to abide by
33	the terms and conditions for participation established by the plan or issuer. Nothing in this section
34	shall be construed as preventing a group health plan, or a health insurance issuer, from
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1	establishing varying reimbursement rates based on quality or performance measures.
2	SECTION 4. Section 27-41-57 of the General Laws in Chapter 27-41 entitled "Health
3	Maintenance Organizations" is hereby amended to read as follows:
4	27-41-57. Acupuncture services. -- Acupuncture sand Oriental medicine services. --
5	(a) Every individual or group health insurance contract, plan, or group policy delivered, issued for
6	delivery or renewed in this state which provides medical coverage, and every individual or group
7	policy which provides for treatment of persons for the prevention, cure or correction of any
8	illness or physical or mental condition shall provide, as an optional rider, coverage for the
9	services, within the scope of practice, of a doctor of acupuncture and Oriental medicine licensed
10	under chapter 37.2 of title 5 as a provider of acupuncture services.
11	(b) For the purposes of this section:
12	(1) "Doctor of acupuncture" means a practitioner licensed under chapter 37.2 of title 5.
13	(2) "Coverage for the services of a doctor of acupuncture as a provider of acupuncture
14	services" means coverage for acupuncture as defined in section 5-37.2-2(1).
15	(c) It remains within the sole discretion of the health maintenance organization as to
16	which doctor of acupuncture and Oriental medicine it contracts with. Reimbursement is provided
17	according to the respective principles and policies of the health maintenance organization;
18	provided, that no health maintenance organization is required to pay for duplicative services
19	actually rendered by a doctor of acupuncture and Oriental medicine and any other health care
20	provider. Nothing contained in this section precludes the health maintenance organization from
21	conducting managed care, medical necessity or utilization review.
22	(d) Providers. – A group health plan and a health insurance issuer offering group or
23	individual health insurance coverage shall not discriminate with respect to participation under the
24	plan or coverage against any health care provider who is acting within the scope of that provider's
25	license or certification under applicable state law. This section shall not require that a group
26	health plan or health insurance issuer contract with any health care provider willing to abide by
27	the terms and conditions for participation established by the plan or issuer. Nothing in this section
28	shall be construed as preventing a group health plan, or a health insurance issuer, from
29	establishing varying reimbursement rates based on quality or performance measures.
30	SECTION 5. This act shall take effect on January 1, 2017.
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	EXPLANATION
	BY THE LEGISLATIVE COUNCIL
	OF
	A N A C T
	RELATING TO INSURANCE - HEALTH INSURANCE
	***
1	This act would require health insurance contracts, plans, and policies to provide
2	coverage, rather than as an optional rider, for the services, within the scope of practice, of
3	licensed doctors of acupuncture and Oriental medicine. This act would also prohibit group health
4	plans and health insurance issuers from discriminating with respect to participation under the plan
5	or coverage against any health care provider who is acting within the scope of that provider's
6	license or certification under applicable law.
7	This act would take effect on January 1, 2017.
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