2016 -- S 2464 SUBSTITUTE A

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LC004774/SUB A/2

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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:

     SECTION 1. Section 27-18-55 of the General Laws in Chapter 27-18 entitled "Accident

and Sickness Insurance Policies" is hereby amended to read as follows:

     27-18-55. Acupuncture services. -- Acupuncture and Oriental medicine services. --

(a) Every group health insurance contract, plan, or group policy delivered, issued for delivery or

renewed in this state which provides medical coverage, and every group policy which provides

for treatment of persons for the prevention, cure or correction of any illness or physical or mental

condition, shall provide, as an optional rider, coverage for the services, within the scope of

practice, of a doctor of acupuncture and Oriental medicine licensed under chapter 37.2 of title 5

as a provider of acupuncture services; provided, that this section shall not apply to insurance

coverage providing benefits for: (1) hospital confinement indemnity; (2) disability income; (3)

accident only; (4) long term care; (5) Medicare supplement; (6) limited benefit health; (7)

specified disease indemnity; (8) sickness or bodily injury or death by accident or both; and (9)

other limited benefit policies.

      (b) For the purposes of this section:

     (1) "Doctor of acupuncture" means a practitioner licensed under chapter 37.2 of title 5.

     (2) "Coverage for the services of a doctor of acupuncture as a provider of acupuncture

services" means coverage for acupuncture as defined in § 5-37.2-2(1).

      (c)(b) It shall remain within the sole discretion of the accident and sickness insurer as to

which doctor of acupuncture and Oriental medicine it shall contract with. Reimbursement shall be

provided according to the respective principles and policies of the accident and sickness insurer;

provided, that no accident and sickness insurer may be required to pay for duplicative services

actually rendered by a doctor of acupuncture and Oriental medicine and any other health care

provider. Nothing contained in this section shall preclude the accident and sickness insurer from

conducting managed care, medical necessity or utilization review.

     (c) Providers. – A group health plan and a health insurance issuer offering group or

individual health insurance coverage shall not discriminate with respect to participation under the

plan or coverage against any health care provider who is acting within the scope of that provider's

license or certification under applicable state law. This section shall not require that a group

health plan or health insurance issuer contract with any health care provider willing to abide by

the terms and conditions for participation established by the plan or issuer. Nothing in this section

shall be construed as preventing a group health plan, or a health insurance issuer, from

establishing varying reimbursement rates based on quality or performance measures.

     SECTION 2. Section 27-19-47 of the General Laws in Chapter 27-19 entitled "Nonprofit

Hospital Service Corporations" is hereby amended to read as follows:

     27-19-47. Acupuncture services. -- Acupuncture and Oriental medicine services. --

(a) Every group health insurance contract, plan, or group policy delivered, issued for delivery or

renewed in this state which provides medical coverage, and every group policy which provides

for treatment of persons for the prevention, cure or correction of any illness or physical or mental

condition, shall provide, as an optional rider, coverage for the services, within the scope of

practice, of a doctor of acupuncture and Oriental medicine licensed under chapter 37.2 of title 5

as a provider of acupuncture services.

      (b) For the purposes of this section:

      (1) "Doctor of acupuncture" means a practitioner licensed under chapter 37.2 of title 5.

      (2) "Coverage for the services of a doctor of acupuncture as a provider of acupuncture

services" means coverage for acupuncture as defined in § 5-37.2-2(1).

      (c)(b) It remains within the sole discretion of the non-profit hospital service corporation

as to which doctor of acupuncture and Oriental medicine it shall contract with. Reimbursement is

provided according to the respective principles and policies of the non-profit hospital service

corporation; provided, that no non-profit hospital service corporation is required to pay for

duplicative services actually rendered by a doctor of acupuncture and Oriental medicine and any

other health care provider. Nothing contained in this section precludes the non-profit hospital

service corporations from conducting managed care, medical necessity or utilization review.

     (c) Providers. – A group health plan and a health insurance issuer offering group or

LC004774/SUB A/2 - Page 2 of 4

individual health insurance coverage shall not discriminate with respect to participation under the

plan or coverage against any health care provider who is acting within the scope of that provider's

license or certification under applicable state law. This section shall not require that a group

health plan or health insurance issuer contract with any health care provider willing to abide by

the terms and conditions for participation established by the plan or issuer. Nothing in this section

shall be construed as preventing a group health plan, or a health insurance issuer, from

establishing varying reimbursement rates based on quality or performance measures.

     SECTION 3. Section 27-20-42 of the General Laws in Chapter 27-20 entitled "Nonprofit

Medical Service Corporations" is hereby amended to read as follows:

     27-20-42. Acupuncture services. -- Acupuncture and Oriental medicine services. --

(a) Every group health insurance contract, plan, or group policy delivered, issued for delivery or

renewed in this state which provides medical coverage, and every group policy which provides

for treatment of persons for the prevention, cure or correction of any illness or physical or mental

condition shall provide, as an optional rider, coverage for the services, within the scope of

practice, of a doctor of acupuncture and Oriental medicine licensed under chapter 37.2 of title 5

as a provider of acupuncture services.

      (b) For the purposes of this section:

      (1) "Doctor of acupuncture" means a practitioner licensed under chapter 37.2 of title 5.

      (2) "Coverage for the services of a doctor of acupuncture as a provider of acupuncture

services" means coverage for acupuncture as defined in § 5-37.2-2(1).

      (c)(b) It remains within the sole discretion of the non-profit medical service corporation

as to which doctor of acupuncture and Oriental medicine it contracts with. Reimbursement is

provided according to the respective principles and policies of the non-profit medical service

corporation; provided, that no non-profit medical service corporation may be required to pay for

duplicative services actually rendered by a doctor of acupuncture and Oriental medicine and any

other health care provider. Nothing contained in this section precludes non-profit medical service

corporations from conducting managed care, medical necessity or utilization review.

     (c) Providers. – A group health plan and a health insurance issuer offering group or

individual health insurance coverage shall not discriminate with respect to participation under the

plan or coverage against any health care provider who is acting within the scope of that provider's

license or certification under applicable state law. This section shall not require that a group

health plan or health insurance issuer contract with any health care provider willing to abide by

the terms and conditions for participation established by the plan or issuer. Nothing in this section

shall be construed as preventing a group health plan, or a health insurance issuer, from

LC004774/SUB A/2 - Page 3 of 4

establishing varying reimbursement rates based on quality or performance measures.

     SECTION 4. Section 27-41-57 of the General Laws in Chapter 27-41 entitled "Health

Maintenance Organizations" is hereby amended to read as follows:

     27-41-57. Acupuncture services. -- Acupuncture sand Oriental medicine services. --

(a) Every group health insurance contract, plan, or group policy delivered, issued for delivery or

renewed in this state which provides medical coverage, and every group policy which provides

for treatment of persons for the prevention, cure or correction of any illness or physical or mental

condition shall provide, as an optional rider, coverage for the services, within the scope of

practice, of a doctor of acupuncture and Oriental medicine licensed under chapter 37.2 of title 5

as a provider of acupuncture services.

      (b) For the purposes of this section:

      (1) "Doctor of acupuncture" means a practitioner licensed under chapter 37.2 of title 5.

      (2) "Coverage for the services of a doctor of acupuncture as a provider of acupuncture

services" means coverage for acupuncture as defined in section 5-37.2-2(1).

      (c)(b) It remains within the sole discretion of the health maintenance organization as to

which doctor of acupuncture and Oriental medicine it contracts with. Reimbursement is provided

according to the respective principles and policies of the health maintenance organization;

provided, that no health maintenance organization is required to pay for duplicative services

actually rendered by a doctor of acupuncture and Oriental medicine and any other health care

provider. Nothing contained in this section precludes the health maintenance organization from

conducting managed care, medical necessity or utilization review.

     (c) Providers. – A group health plan and a health insurance issuer offering group or

individual health insurance coverage shall not discriminate with respect to participation under the

plan or coverage against any health care provider who is acting within the scope of that provider's

license or certification under applicable state law. This section shall not require that a group

health plan or health insurance issuer contract with any health care provider willing to abide by

the terms and conditions for participation established by the plan or issuer. Nothing in this section

shall be construed as preventing a group health plan, or a health insurance issuer, from

establishing varying reimbursement rates based on quality or performance measures.

     SECTION 5. This act shall take effect on January 1, 2017.

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LC004774/SUB A/2

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LC004774/SUB A/2 - Page 4 of 4

EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE - HEALTH INSURANCE

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     This act would prohibit health insurance insurers from discriminating against any health

care provider, who is acting within the scope of their license or certification, concerning

participation and coverage in their plan.

     This act would take effect on January 1, 2017.

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LC004774/SUB A/2

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