2020 -- H 7837

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LC004925

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2020

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A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

     Introduced By: Representatives Casey, Kennedy, Solomon, Kazarian, and Williams

     Date Introduced: February 26, 2020

     Referred To: House Health, Education & Welfare

     It is enacted by the General Assembly as follows:

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

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

     27-18-85. Coverage for covered services provided by naturopathic physicians.

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

mental condition, shall provide coverage for health care services covered by the plan when provided

by a naturopathic doctor licensed in this state for treatment within the scope of practice described

in § 5-36.1-3. Health care services provided by naturopathic doctors may be subject to reasonable

deductibles, co-payment and coinsurance amounts, and fee or benefit limits consistent with those

applicable to other specialists under the plan, as well as practice parameters, cost-effectiveness and

clinical efficacy standards, and utilization review consistent with any applicable rule and regulation

promulgated by the department of business regulation. Any amount, limit, standard and review

shall not function to direct treatment in any manner unfairly discriminative against naturopathic

care, and collectively shall not be more restrictive than those applicable under the same policy to

care or services provided by other specialists but may allow for the management of benefit

consistent with variations in practice patterns and treatment modalities among the different types

of health care providers.

     (b) A health insurance plan may require the naturopathic doctor's services be provided by

a licensed naturopathic doctor under contract with the insurer or shall be covered in a manner

consistent with out-of-network provider reimbursement practices for primary care physicians;

however, this shall not relieve a health insurance plan from compliance with the applicable network

adequacy requirements.

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

naturopathic doctor it shall contract with. Nothing herein shall require an accident and sickness

insurer to pay for duplicative services actually rendered by a naturopathic doctor and any other

health care provider.

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

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

     27-19-77. Coverage for covered services provided by naturopathic physicians.

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

mental condition, shall provide coverage for health care services covered by the plan when provided

by a naturopathic doctor licensed in this state for treatment within the scope of practice described

in § 5-36.1-3. Health care services provided by naturopathic doctors may be subject to reasonable

deductibles, co-payment and coinsurance amounts, and fee or benefit limits consistent with those

applicable to other primary care physicians under the plan, as well as practice parameters, cost

effectiveness and clinical efficacy standards, and utilization review consistent with any applicable

rule and regulation promulgated by the department of business regulation. Any amount, limit,

standard and review shall not function to direct treatment in any manner unfairly discriminative

against naturopathic care, and collectively shall not be more restrictive than those applicable under

the same policy to care or services provided by other specialists, but may allow for the management

of benefit consistent with variations in practice patterns and treatment modalities among the

different types of health care providers.

     (b) A health insurance plan may require the naturopathic doctor's services be provided by

a licensed naturopathic doctor under contract with the insurer or shall be covered in a manner

consistent with out-of-network provider reimbursement practices for specialists; however, this shall

not relieve a health insurance plan from compliance with the applicable network adequacy

requirements.

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

as to which naturopathic doctor it shall contract with. Nothing herein shall require an accident and

sickness insurer to pay for duplicative services actually rendered by a naturopathic doctor and any

LC004925 - Page 2 of 5

other health care provider.

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

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

     27-20-73. Coverage for covered services provided by naturopathic physicians.

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

mental condition, shall provide coverage for health care services covered by the plan when provided

by a naturopathic doctor licensed in this state for treatment within the scope of practice described

in § 5-36.1-3. Health care services provided by naturopathic doctors may be subject to reasonable

deductibles, co-payment and coinsurance amounts, and fee or benefit limits consistent with those

applicable to other specialists under the plan, as well as practice parameters, cost-effectiveness and

clinical efficacy standards, and utilization review consistent with any applicable rule and regulation

promulgated by the department of business regulation. Any amount, limit, standard and review

shall not function to direct treatment in any manner unfairly discriminative against naturopathic

care, and collectively shall not be more restrictive than those applicable under the same policy to

care or services provided by other specialists, but may allow for the management of benefit

consistent with variations in practice patterns and treatment modalities among the different types

of health care providers.

     (b) A health insurance plan may require the naturopathic doctor's services be provided by

a licensed naturopathic doctor under contract with the insurer or shall be covered in a manner

consistent with out-of-network provider reimbursement practices for specialists; however, this shall

not relieve a health insurance plan from compliance with the applicable network adequacy

requirements.

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

as to which naturopathic doctor it shall contract with. Nothing herein shall require an accident and

sickness insurer to pay for duplicative services actually rendered by a naturopathic doctor and any

other health care provider.

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

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

     27-41-90. Coverage for covered services provided by naturopathic physicians.

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

LC004925 - Page 3 of 5

mental condition, shall provide coverage for health care services covered by the plan when provided

by a naturopathic doctor licensed in this state for treatment within the scope of practice described

in § 5-36.1-3. Health care services provided by naturopathic doctors may be subject to reasonable

deductibles, co-payment and coinsurance amounts, and fee or benefit limits consistent with those

applicable to other specialists under the plan, as well as practice parameters, cost-effectiveness and

clinical efficacy standards, and utilization review consistent with any applicable rule and regulation

promulgated by the department of business regulation. Any amount, limit, standard and review

shall not function to direct treatment in any manner unfairly discriminative against naturopathic

care, and collectively shall not be more restrictive than those applicable under the same policy to

care or services provided by other specialists, but may allow for the management of benefit

consistent with variations in practice patterns and treatment modalities among the different types

of health care providers.

     (b) A health insurance plan may require the naturopathic doctor's services be provided by

a licensed naturopathic doctor under contract with the insurer or shall be covered in a manner

consistent with out-of-network provider reimbursement practices for specialists; however, this shall

not relieve a health insurance plan from compliance with the applicable network adequacy

requirements.

     (c) It shall remain within the sole discretion of the health maintenance organization as to

which naturopathic doctor it shall contract with. Nothing herein shall require an accident and

sickness insurer to pay for duplicative services actually rendered by a naturopathic doctor and any

other health care provider.

     SECTION 5. This act shall take effect upon passage.

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LC004925

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

***

     This act would require insurance coverage for health care services provided by a

naturopathic doctor licensed in this state.

     This act would take effect upon passage.

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