2019 -- S 0570

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2019

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A N   A C T

RELATING TO STATE AFFAIRS AND GOVERNMENT -- THE HEALTH CARE SERVICES

FUNDING PLAN ACT

     

     Introduced By: Senators Valverde, and Goldin

     Date Introduced: March 14, 2019

     Referred To: Senate Health & Human Services

     (Dept. of Health)

It is enacted by the General Assembly as follows:

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     SECTION 1. Section 42-7.4-2 of the General Laws in Chapter 42-7.4 entitled "The

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Health Care Services Funding Plan Act" is hereby amended to read as follows:

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     42-7.4-2. Definitions.

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     The following words and phrases as used in this chapter shall have the following

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meaning:

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     (1) "Secretary" means the secretary of health and human services.

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     (2)(i) "Insurer" means all persons offering, administering, and/or insuring healthcare

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services, including, but not limited to:

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     (A) Policies of accident and sickness insurance, as defined by chapter 18 of title 27:

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     (B) Nonprofit hospital or medical-service plans, as defined by chapters 19 and 20 of title

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27;

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     (C) Any person whose primary function is to provide diagnostic, therapeutic, or

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preventive services to a defined population on the basis of a periodic premium;

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     (D) All domestic, foreign, or alien insurance companies, mutual associations and

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organizations;

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     (E) Health maintenance organizations, as defined by chapter 41 of title 27;

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     (F) All persons providing health benefits coverage on a self-insurance basis;

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     (G) All third-party administrators described in chapter 20.7 of title 27; and

 

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     (H) All persons providing health benefit coverage under Title XIX of the Social Security

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Act (Medicaid) as a Medicaid managed care organization offering managed Medicaid.

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     (ii) "Insurer" shall not include any nonprofit dental service corporation as defined in § 27-

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20.1-2, nor any insurer offering only those coverages described in § 42-7.4-14.

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     (3)(i) "Contribution enrollee" means an individual residing in this state, with respect to

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whom an insurer administers, provides, pays for, insures, or covers health-care services, unless

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excepted by this section.

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     (ii) "Contribution enrollee" shall not include an individual whose healthcare services are

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paid or reimbursed by Part A or Part B of the Medicare program, a Medicare supplemental policy

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as defined in section 1882(g)(1) of the Social Security Act, 42 U.S.C. § 1395ss(g)(1), or Medicare

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managed care policy, the federal employees' health benefit program, Tricare, CHAMPUS, the

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Veterans' healthcare program, the Indian health service program, or any local governmental

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corporation, district, or agency providing health benefits coverage on a self-insured basis;

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     (iii) Delayed applicability for state employees, retirees, and dependents and not-for-profit

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healthcare corporations. An individual whose healthcare services are paid or reimbursed by the

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state of Rhode Island pursuant to chapter 12 of title 36 or a not-for-profit healthcare corporation

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that controls or operates hospitals licensed under chapter 17 of title 23 or a not-for-profit

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healthcare corporation that controls or operates hospitals licensed under chapter 17 of title 23, and

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facilities and programs providing rehabilitation, psychological support, and social guidance to

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individuals who are alcoholic, drug abusers, mentally ill or who are persons with developmental

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disabilities or cognitive disabilities such as brain injury, licensed under chapter 24 of title 40.1

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shall not be treated as a "contribution enrollee" until July 1, 2016.

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     (4) "Person" means any individual, corporation, company, association, partnership,

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limited liability company, firm, state governmental corporations, districts, and agencies, joint

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stock associations, trusts, and the legal successor thereof.

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     (5) "Healthcare services funding contribution" means per capita amount each contributing

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insurer must contribute to support the programs funded by the method established under this

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section, with respect to each contribution enrollee; provided, however, that, with respect to an

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insurer that is a Medicaid managed care organization offering managed Medicaid, the healthcare

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funding services contribution for any contribution enrollee whose healthcare services are paid or

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reimbursed under Title XIX of the Social Security Act (Medicaid) shall not include the children's

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health services funding requirement described in § 42-12-29.

 

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     SECTION 2. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO STATE AFFAIRS AND GOVERNMENT -- THE HEALTH CARE SERVICES

FUNDING PLAN ACT

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     This act would require Tricare to pay the healthcare services funding contributions for

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their contribution enrollees.

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     This act would take effect upon passage.

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