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:

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     SECTION 1. Chapter 27-18 of the General Laws entitled "Accident and Sickness

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Insurance Policies" is hereby amended by adding thereto the following section:

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     27-18-84. Contracts with health care providers.

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     (a) It shall be the policy of this state that a participating provider agreement between a

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health insurance carrier and a health benefit plan subject to the jurisdiction of the commissioner

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pursuant to the provisions of this chapter and a professional group practice or health care facility

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shall be legally sufficient to bind all licensed health care providers employed by, or under

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contract to, that group practice or facility.

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     (b) If a health insurance carrier and a health benefit plan subject to the jurisdiction of the

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commissioner pursuant to the provisions of this chapter directly or indirectly contracts with a

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group practice or health care facility to provide health care to a health insurance carrier and health

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benefit plan's members, the health insurance carrier and health benefit plan shall be prohibited

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from requiring individual contracts between the health insurance carrier and health benefit plan

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and individual health care providers employed by, or under independent contract with, the group

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or facility for services covered by the group or facility agreement.

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     (c) Nothing in this section shall prohibit a health insurance carrier and a health benefit

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plan from entering into contracts with individual licensed health care providers when the health

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care services to be provided under the individual contracts are not covered by a different

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participating provider agreement.

 

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     SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service

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Corporations" is hereby amended by adding thereto the following section:

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     27-19-76. Contracts with health care providers.

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     (a) It shall be the policy of this state that a participating provider agreement between a

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nonprofit hospital service corporation and a professional group practice or health care facility

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shall be legally sufficient to bind all licensed health care providers employed by, or under

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contract to, that group practice or facility.

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     (b) If a nonprofit hospital service corporations directly or indirectly contracts with a

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group practice or health care facility to provide health care to the nonprofit hospital service

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corporation's members, the nonprofit hospital service corporation shall be prohibited from

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requiring individual contracts between the nonprofit hospital service corporation and individual

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health care providers employed by, or under independent contract with, the group or facility for

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services covered by the group or facility agreement.

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     (c) Nothing in this section shall prohibit a nonprofit hospital service corporation from

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entering into contracts with individual licensed health care providers when the health care

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services to be provided under the individual contracts are not covered by a different participating

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provider agreement

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     SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service

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Corporations" is hereby amended by adding thereto the following section:

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     27-20-72. Contracts with health care providers.

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     (a) It shall be the policy of this state that a participating provider agreement between a

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nonprofit medical service corporation and a professional group practice or health care facility

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shall be legally sufficient to bind all licensed health care providers employed by, or under

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contract to, that group practice or facility.

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     (b) If a nonprofit medical service corporation directly or indirectly contracts with a group

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practice or health care facility to provide health care to the nonprofit medical service

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corporation's members, the nonprofit medical service corporation shall be prohibited from

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requiring individual contracts between the nonprofit medical service corporation and individual

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health care providers employed by, or under independent contract with, the group or facility for

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services covered by the group or facility agreement.

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     (c) Nothing in this section shall prohibit a nonprofit medical service corporation from

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entering into contracts with individual licensed health care providers when the health care

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services to be provided under the individual contracts are not covered by a different participating

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provider agreement.

 

LC004970 - Page 2 of 4

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     SECTION 4. Chapter 27-41 of the General Laws entitled "Health Maintenance

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Organizations" is hereby amended by adding thereto the following section:

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     27-41-89. Contracts with health care providers.

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     (a) It shall be the policy of this state that a participating provider agreement between a

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health maintenance organization (HMO) and a professional group practice or health care facility

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shall be legally sufficient to bind all licensed health care providers employed by, or under

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contract to, that group practice or facility.

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     (b) If a health maintenance organization directly or indirectly contracts with a group

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practice or health care facility to provide health care to the health maintenance organization's

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members, the health maintenance organization shall be prohibited from requiring individual

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contracts between the HMO and individual health care providers employed by, or under

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independent contract with, the group or facility for services covered by the group or facility

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agreement.

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     (c) Nothing in this section shall prohibit a health maintenance organization from entering

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into contracts with individual licensed health care providers when the health care services to be

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provided under the individual contracts are not covered by a different participating provider

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agreement. Compliance with this section shall not constitute a violation of ยง 27-41-2(t)(3)(i)(B).

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     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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     This act would render participating provider contracts between health insurance carriers

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and health plans with health care providers covered by carrier, group or facility agreements as

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legally sufficient to bind all the licensed health care providers and prohibit the need for individual

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contracts.

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     This act would take effect upon passage.

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LC004970 - Page 4 of 4