2020 -- S 2531

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LC004652

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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 BUSINESSES AND PROFESSIONS -- BOARD OF MEDICAL LICENSURE

AND DISCIPLINE

     

     Introduced By: Senators Sheehan, Crowley, Picard, Metts, and Satchell

     Date Introduced: February 25, 2020

     Referred To: Senate Health & Human Services

     It is enacted by the General Assembly as follows:

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     SECTION 1. Chapter 5-37 of the General Laws entitled "Board of Medical Licensure and

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

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     5-37-2.2. Prohibition of board certification requirement to practice medicine.

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     Notwithstanding any provision of this chapter to the contrary, the board shall not require a

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physician applicant or physician licensee under its jurisdiction to obtain or maintain a national or

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regional board certification that is not otherwise specifically required in this chapter before it issues

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a license or license renewal to that physician applicant or physician licensee under this chapter.

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     SECTION 2. Section 27-20.6-1 of the General Laws in Chapter 27-20.6 entitled "Health

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Care Insurers - Coordination of Benefits" is hereby amended to read as follows:

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     27-20.6-1. Definitions.

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     As used in this chapter, the following terms shall have the following meanings:

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     (1) “Continued board certification” means an ongoing recertification program through

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which physicians are recertified by one or more of the national or regional medical boards, which

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includes, but is not limited to, one or more of the medical specialty boards of the American Board

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of Medical Specialties, the American Osteopathic Association, the National Board of Physicians

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and Surgeons, or any other nationally or regionally-recognized entity providing medical specialty

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certification. Continued board certification is separate from and in addition to any recertification

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and continuing medical education requirements required pursuant to § 5-37-2.1.

 

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     (2) "Hospital" means a person or governmental entity licensed in accordance with chapter

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17 of title 23 to establish, maintain, and operate a hospital.

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     (1)(3) "Insurer" means every nonprofit medical service corporation, hospital service

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corporation, health maintenance organization, or other insurer offering and/or insuring health

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services; the term shall in addition include any entity defined as an insurer under § 42-62-4; and .

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     (4) Physician" means a person with a license to practice allopathic or osteopathic medicine

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in this state under the provisions of chapter 17 of title 23.

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     (2)(5) "Primary insurer" means the insurer primarily liable in accordance with the anti-

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duplication provisions established by regulations promulgated by the director of business

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regulation.

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     SECTION 3. Chapter 27-20.6 of the General Laws entitled "Health Care Insurers -

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Coordination of Benefits" is hereby amended by adding thereto the following section:

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     27-20.6-3.1. Continued board certification not to be considered in coordination of

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benefits.

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     An insurer shall not:

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     (1) Deny reimbursement to a physician or hospital for services rendered because the

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physician or any physicians within the hospital have not completed continued board certification.

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     (2) Provide lower reimbursement for services rendered by a physician or hospital because

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the physician or any physicians within the hospital have not completed continued board

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certification.

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     (3) Prohibit a physician or hospital from participating in any of the insurer’s provider

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networks because the physician or any physicians within the hospital have not completed continued

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board certification.

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     (4) Determine a contractual relationship with, or credentialing of, a physician or hospital

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based upon the physician or any physician within the hospital’s completion or lack of completion

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of continued board certification.

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     (5) Deny reimbursement to a physician or hospital for services rendered based upon which

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continued board certification program or programs the physician or any physicians within the

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hospital have completed.

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     (6) Provide lower reimbursement to a physician or hospital for services rendered based

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upon which continued board certification program or programs the physician or any physicians

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within the hospital have completed.

 

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     SECTION 4. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO BUSINESSES AND PROFESSIONS -- BOARD OF MEDICAL LICENSURE

AND DISCIPLINE

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     This act would prohibit the board of medical licensure and discipline from requiring

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specialty board certification as a condition of licensure. This act would also provide that a health

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care insurer would not deny reimbursement or provide lower reimbursement rates to a physician or

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hospital, based on a physician’s decision whether or not to participate in a national continued board

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certification program.

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     This act would take effect upon passage.

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