2016 -- H 7785

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LC004183

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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 - ACCIDENT AND SICKNESS INSURANCE POLICIES

     

     Introduced By: Representative Gregg Amore

     Date Introduced: March 02, 2016

     Referred To: House Corporations

     It is enacted by the General Assembly as follows:

1

     SECTION 1. Section 27-18-48 of the General Laws in Chapter 27-18 entitled "Accident

2

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

3

     27-18-48. Third-party reimbursement for services of certain health care workers. --

4

(a) Every individual or group hospital or medical services plan contract delivered, issued or

5

renewed by an insurer or nonprofit or for-profit health service corporation that provides benefits

6

to individual subscribers and members within the state, or to all group members having a

7

principal place of employment within the state, shall provide benefits for services rendered by a

8

certified registered nurse anesthetist designated as a certified registered nurse anesthetist by the

9

board of nurse registration and nursing education; provided, that the following conditions are met:

10

      (1) The certified registered nurse anesthetist adheres to the practice of certified registered

11

nurse anesthesia as defined by, and in accordance with, § 5-34.2-2.

12

      (2) The policy or contract currently provides benefits for identical services rendered by a

13

provider of health care licensed by the state; and

14

      (3) The certified registered nurse anesthetist is not a salaried employee of the licensed

15

hospital or facility for which the accident and sickness insurer has an alternative contractual

16

relationship to fund the services of a certified registered nurse anesthetist.; and

17

      (b) It shall remain within the sole discretion of the health maintenance organization

18

     (4) The health maintenance organization shall retain the sole discretion as to which

19

certified registered nurse anesthetists it shall contract with. Reimbursement shall be provided

 

1

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

2

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

3

actually rendered by a certified registered nurse anesthetist and any other health care provider.

4

Nothing contained in this section shall preclude the health maintenance organization from

5

conducting managed care, medical necessity, or utilization review.

6

      (c)(b) 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 establishing

13

varying reimbursement rates based on quality or performance measures.

14

     SECTION 2. Section 27-19-40 of the General Laws in Chapter 27-19 entitled "Nonprofit

15

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

16

     27-19-40. Third-party reimbursement for services of certain health care workers. --

17

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

18

renewed by an insurer or nonprofit or for-profit health service corporation that provides benefits

19

to individual subscribers and members within the state, or to all group members having a

20

principal place of employment within the state, shall provide benefits for services rendered by a

21

certified registered nurse anesthetist designated as a certified registered nurse anesthetist by the

22

board of nurse registration and nursing education; provided, that the following conditions are met:

23

      (1) The certified registered nurse anesthetist adheres to the practice of certified registered

24

nurse anesthesia as defined by and in accordance with § 5-34.2-2.

25

      (2) The policy or contract currently provides benefits for identical services rendered by a

26

provider of health care licensed by the state; and

27

      (3) The certified registered nurse anesthetist is not a salaried employee of the licensed

28

hospital or facility for which the nonprofit hospital service corporation has an alternative

29

contractual relationship to fund the services of a certified registered nurse anesthetist.; and

30

      (b) It shall remain within the sole discretion of the nonprofit hospital service corporation

31

(4) The nonprofit hospital service corporation shall retain sole discretion as to which

32

certified registered nurse anesthetists it shall contract with. Reimbursement shall be provided

33

according to the respective principles and policies of the nonprofit hospital service corporation;

34

provided, that no nonprofit hospital service corporation may be required to pay for duplicative

 

LC004183 - Page 2 of 6

1

services actually rendered by a certified registered nurse anesthetist and any other health care

2

provider. Nothing contained in this section shall preclude the nonprofit hospital service

3

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

4

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

5

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

6

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

7

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

8

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

9

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

10

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

11

varying reimbursement rates based on quality or performance measures.

12

     SECTION 3. Section 27-20-35 of the General Laws in Chapter 27-20 entitled "Nonprofit

13

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

14

     27-20-35. Third-party reimbursement for services of certain health care workers. --

15

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

16

renewed by an insurer or nonprofit or for-profit health service corporation that provides benefits

17

to individual subscribers and members within the state, or to all group members having a

18

principal place of employment within the state, shall provide benefits for services rendered by a

19

certified registered nurse anesthetist designated as a certified registered nurse anesthetist by the

20

board of nurse registration and nursing education; provided, that the following conditions are met:

21

      (1) The certified registered nurse anesthetist adheres to the practice of certified registered

22

nurse anesthesia as defined by and in accordance with § 5-34.2-2.

23

      (2) The policy or contract currently provides benefits for identical services rendered by a

24

provider of health care licensed by the state; and

25

      (3) The certified registered nurse anesthetist is not a salaried employee of the licensed

26

hospital or facility for which the nonprofit medical service corporation has an alternative

27

contractual relationship to fund the services of a certified registered nurse anesthetist.; and

28

      (b) It shall remain within the sole discretion of the nonprofit medical service corporation

29

(4) The nonprofit medical service corporation shall retain sole discretion as to which

30

certified registered nurse anesthetists it shall contract with. Reimbursement shall be provided

31

according to the respective principles and policies of the nonprofit medical service corporation;

32

provided, that no nonprofit medical service corporation may be required to pay for duplicative

33

services actually rendered by a certified registered nurse anesthetist and any other health care

34

provider. Nothing contained in this section shall preclude the nonprofit medical service

 

LC004183 - Page 3 of 6

1

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

2

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

3

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

4

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

5

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

6

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

7

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

8

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

9

varying reimbursement rates based on quality or performance measures.

10

     SECTION 4. Section 27-41-49 of the General Laws in Chapter 27-41 entitled "Health

11

Maintenance Organizations" is hereby amended to read as follows:

12

     27-41-49. Third-party reimbursement for services of certain health care workers. --

13

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

14

renewed by an insurer, health maintenance organization, nonprofit or for-profit health service

15

corporation that provides benefits to individual subscribers and members within the state, or to all

16

group members having a principal place of employment within the state, shall provide benefits

17

for services rendered by a certified registered nurse anesthetist designated as a certified registered

18

nurse anesthetist by the board of nurse registration and nursing education; provided, that the

19

following conditions are met:

20

      (1) The certified registered nurse anesthetist adheres to the practice of certified registered

21

nurse anesthesia as defined by and in accordance with § 5-34.2-2.

22

      (2) The policy or contract currently provides benefits for identical services rendered by a

23

provider of health care licensed by the state; and

24

      (3) The certified registered nurse anesthetist is not a salaried employee of the licensed

25

hospital or facility for which the health maintenance organization has an alternative contractual

26

relationship to fund the services of a certified registered nurse anesthetist.; and

27

      (b) It shall remain within the sole discretion of the health maintenance organization

28

     (4) The health maintenance organization shall retain sole discretion as to which certified

29

registered nurse anesthetists it shall contract with. Reimbursement shall be provided according to

30

the respective principles and policies of the health maintenance organization; provided, that no

31

health maintenance organization may be required to pay for duplicative services actually rendered

32

by a certified registered nurse anesthetist and any other health care provider. Nothing contained in

33

this section shall preclude the health maintenance organization from conducting managed care,

34

medical necessity, or utilization review.

 

LC004183 - Page 4 of 6

1

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

2

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

3

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

4

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

5

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

6

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

7

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

8

varying reimbursement rates based on quality or performance measures.

9

     SECTION 5. This act shall take effect upon passage.

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LC004183

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LC004183 - Page 5 of 6

EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE - ACCIDENT AND SICKNESS INSURANCE POLICIES

***

1

     This act would clarify that health maintenance organizations would retain the sole

2

discretion as to which certified nurse anesthetists it contracts with.

3

     This act would take effect upon passage.

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LC004183

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LC004183 - Page 6 of 6