S2536

	2018 -- S 2536
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	LC004970
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	STATE OF RHODE ISLAND
	IN GENERAL ASSEMBLY
	JANUARY SESSION, A.D. 2018
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	A N A C T
	RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

	Introduced By: Senator Adam J. Satchell
	Date Introduced: March 01, 2018
	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	27-18-84. Contracts with health care providers.
4	(a) It shall be the policy of this state that a participating provider agreement between a
5	health insurance carrier and a health benefit plan subject to the jurisdiction of the commissioner
6	pursuant to the provisions of this chapter and a professional group practice or health care facility
7	shall be legally sufficient to bind all licensed health care providers employed by, or under
8	contract to, that group practice or facility.
9	(b) If a health insurance carrier and a health benefit plan subject to the jurisdiction of the
10	commissioner pursuant to the provisions of this chapter directly or indirectly contracts with a
11	group practice or health care facility to provide health care to a health insurance carrier and health
12	benefit plan's members, the health insurance carrier and health benefit plan shall be prohibited
13	from requiring individual contracts between the health insurance carrier and health benefit plan
14	and individual health care providers employed by, or under independent contract with, the group
15	or facility for services covered by the group or facility agreement.
16	(c) Nothing in this section shall prohibit a health insurance carrier and a health benefit
17	plan from entering into contracts with individual licensed health care providers when the health
18	care services to be provided under the individual contracts are not covered by a different
19	participating provider agreement.

1	SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service
2	Corporations" is hereby amended by adding thereto the following section:
3	27-19-76. Contracts with health care providers.
4	(a) It shall be the policy of this state that a participating provider agreement between a
5	nonprofit hospital service corporation and a professional group practice or health care facility
6	shall be legally sufficient to bind all licensed health care providers employed by, or under
7	contract to, that group practice or facility.
8	(b) If a nonprofit hospital service corporations directly or indirectly contracts with a
9	group practice or health care facility to provide health care to the nonprofit hospital service
10	corporation's members, the nonprofit hospital service corporation shall be prohibited from
11	requiring individual contracts between the nonprofit hospital service corporation and individual
12	health care providers employed by, or under independent contract with, the group or facility for
13	services covered by the group or facility agreement.
14	(c) Nothing in this section shall prohibit a nonprofit hospital service corporation from
15	entering into contracts with individual licensed health care providers when the health care
16	services to be provided under the individual contracts are not covered by a different participating
17	provider agreement
18	SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service
19	Corporations" is hereby amended by adding thereto the following section:
20	27-20-72. Contracts with health care providers.
21	(a) It shall be the policy of this state that a participating provider agreement between a
22	nonprofit medical service corporation and a professional group practice or health care facility
23	shall be legally sufficient to bind all licensed health care providers employed by, or under
24	contract to, that group practice or facility.
25	(b) If a nonprofit medical service corporation directly or indirectly contracts with a group
26	practice or health care facility to provide health care to the nonprofit medical service
27	corporation's members, the nonprofit medical service corporation shall be prohibited from
28	requiring individual contracts between the nonprofit medical service corporation and individual
29	health care providers employed by, or under independent contract with, the group or facility for
30	services covered by the group or facility agreement.
31	(c) Nothing in this section shall prohibit a nonprofit medical service corporation from
32	entering into contracts with individual licensed health care providers when the health care
33	services to be provided under the individual contracts are not covered by a different participating
34	provider agreement.
	LC004970 - Page 2 of 4
1	SECTION 4. Chapter 27-41 of the General Laws entitled "Health Maintenance
2	Organizations" is hereby amended by adding thereto the following section:
3	27-41-89. Contracts with health care providers.
4	(a) It shall be the policy of this state that a participating provider agreement between a
5	health maintenance organization (HMO) and a professional group practice or health care facility
6	shall be legally sufficient to bind all licensed health care providers employed by, or under
7	contract to, that group practice or facility.
8	(b) If a health maintenance organization directly or indirectly contracts with a group
9	practice or health care facility to provide health care to the health maintenance organization's
10	members, the health maintenance organization shall be prohibited from requiring individual
11	contracts between the HMO and individual health care providers employed by, or under
12	independent contract with, the group or facility for services covered by the group or facility
13	agreement.
14	(c) Nothing in this section shall prohibit a health maintenance organization from entering
15	into contracts with individual licensed health care providers when the health care services to be
16	provided under the individual contracts are not covered by a different participating provider
17	agreement. Compliance with this section shall not constitute a violation of § 27-41-2(t)(3)(i)(B).
18	SECTION 5. 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 render participating provider contracts between health insurance carriers
2	and health plans with health care providers covered by carrier, group or facility agreements as
3	legally sufficient to bind all the licensed health care providers and prohibit the need for individual
4	contracts.
5	This act would take effect upon passage.
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