Chapter
099
2005 -- S 0423 SUBSTITUTE B
Enacted 06/28/05
A N A C T
RELATING
TO INSURANCE -- EARLY INTERVENTION SERVICES
Introduced
By: Senators Cote, Paiva-Weed, J Montalbano, Perry, and Badeau
Date
Introduced: February 10, 2005
It is enacted by the General Assembly as
follows:
SECTION 1. Section
27-18-64 of the General Laws in Chapter 27-18 entitled "Accident
and Sickness Insurance Policies" is hereby
amended to read as follows:
27-18-64.
Coverage for early intervention services. -- (a) Every individual or
group
hospital or medical expense insurance policy or
contract providing coverage for dependent
children, delivered or renewed in this state on
or after the effective date of this act [July 1, 2004]
shall include coverage of early intervention
services which coverage shall take effect no later than
January 1, 2005. Such coverage shall be limited
to a benefit of five thousand dollars ($5,000) per
dependent child per policy or calendar year and
shall not be subject to deductibles and
coinsurance factors. Any amount paid by an
insurer under this section for a dependent child shall
not be applied to any annual or lifetime maximum
benefit contained in the policy or contract. For
the purpose of this section, "early
intervention services" means, but is not limited to, speech and
language therapy, occupational therapy, physical
therapy, evaluation, case management, nutrition,
service plan development and review, nursing
services, and assistive technology services and
devices for dependents from birth to age three
(3) who are certified by the department of human
services as eligible for services under part C
of the Individuals with Disabilities Education Act
(20 U.S.C. sec. 1471 et seq.).
(b) Subject to
the annual limits provided in this section, insurers shall reimburse certified
early intervention providers, who are designated
as such by the Department of Human Services,
for early intervention services as defined in
this section at rates of reimbursement equal to or
greater than the prevailing integrated
state/Medicaid rate for early intervention services as
established by the Department of Human Services.
(c) This
section shall not apply to insurance coverage providing benefits for: (1)
hospital
confinement indemnity; (2) disability income;
(3) accident only; (4) long-term care; (5) Medicare
supplement; (6) limited benefit health; (7)
specified disease indemnity; (8) sickness or bodily
injury or death by accident or both; and (9)
other limited benefit policies.
SECTION 2. Section
27-19-55 of the General Laws in Chapter 27-19 entitled "Nonprofit
Hospital Service Corporations" is hereby
amended to read as follows:
27-19-55.
Coverage for early intervention services. -- (a) Every individual or
group
hospital or medical expense insurance policy or
contract providing coverage for dependent
children, delivered or renewed in this state on
or after the effective date of this act [July 1, 2004]
shall include coverage of early intervention
services which coverage shall take effect no later than
January 1, 2005. Such coverage shall be limited
to a benefit of five thousand dollars ($5,000) per
dependent child per policy or calendar year and
shall not be subject to deductibles and
coinsurance factors. Any amount paid by an
insurer under this section for a dependent child shall
not be applied to any annual or lifetime maximum
benefit contained in the policy or contract. For
the purpose of this section, "early
intervention services" means, but is not limited to, speech and
language therapy, occupational therapy, physical
therapy, evaluation, case management, nutrition,
service plan development and review, nursing
services, and assistive technology services and
devices for dependents from birth to age three
(3) who are certified by the department of human
services as eligible for services under part C
of the Individuals with Disabilities Education Act
(20 U.S.C. section 1471 et seq.).
(b) Subject to
the annual limits provided in this section, insurers shall reimburse certified
early intervention providers, who are designated
as such by the Department of Human Services,
for early intervention services as defined in
this section at rates of reimbursement equal to or
greater than the prevailing integrated
state/Medicaid rate for early intervention services as
established by the Department of Human Services.
(c) This
section shall not apply to insurance coverage providing benefits for: (1)
hospital
confinement indemnity; (2) disability income;
(3) accident only; (4) long-term care; (5) Medicare
supplement; (6) limited benefit health; (7) specified
disease indemnity; (8) sickness or bodily
injury or death by accident or both; and (9)
other limited benefit policies.
SECTION 3. Section
27-20-50 of the General Laws in Chapter 27-20 entitled "Nonprofit
Medical Service Corporations" is hereby
amended to read as follows:
27-20-50.
Coverage for early intervention services. -- (a) Every individual or
group
hospital or medical expense insurance policy or
contract providing coverage for dependent
children, delivered or renewed in this state on
or after the effective date of this act [July 1, 2004]
shall include coverage of early intervention
services which coverage shall take effect no later than
January 1, 2005. Such coverage shall be limited
to a benefit of five thousand dollars ($5,000) per
dependent child per policy or calendar year and
shall not be subject to deductibles and
coinsurance factors. Any amount paid by an
insurer under this section for a dependent child shall
not be applied to any annual or lifetime maximum
benefit contained in the policy or contract. For
the purpose of this section, "early
intervention services" means, but is not limited to, speech and
language therapy, occupational therapy, physical
therapy, evaluation, case management, nutrition,
service plan development and review, nursing
services, and assistive technology services and
devices for dependents from birth to age three
(3) who are certified by the department of human
services as eligible for services under part C
of the Individuals with Disabilities Education Act
(20 U.S.C. section 1471 et seq.).
(b) Subject to
the annual limits provided in this section, insurers shall reimburse certified
early intervention providers, who are designated
as such by the Department of Human Services,
for early intervention services as defined in
this section at rates of reimbursement equal to or
greater than the prevailing integrated
state/Medicaid rate for early intervention services as
established by the Department of Human Services.
(c) This section
shall not apply to insurance coverage providing benefits for: (1) hospital
confinement indemnity; (2) disability income;
(3) accident only; (4) long-term care; (5) Medicare
supplement; (6) limited benefit health; (7)
specified disease indemnity; (8) sickness or bodily
injury or death by accident or both; and (9)
other limited benefit policies.
SECTION 4. Section
27-41-68 of the General Laws in Chapter 27-41 entitled "Health
Maintenance Organizations" is hereby
amended to read as follows:
27-41-68.
Coverage for early intervention services. -- (a) Every individual or
group
hospital or medical expense insurance policy or
contract providing coverage for dependent
children, delivered or renewed in this state on
or after the effective date of this act [July 1, 2004]
shall include coverage of early intervention
services which coverage shall take effect no later than
January 1, 2005. Such coverage shall be limited
to a benefit of five thousand dollars ($5,000) per
dependent child per policy or calendar year and
shall not be subject to deductibles and
coinsurance factors. Any amount paid by an
insurer under this section for a dependent child shall
not be applied to any annual or lifetime maximum
benefit contained in the policy or contract. For
the purpose of this section, "early
intervention services" means, but is not limited to, speech and
language therapy, occupational therapy, physical
therapy, evaluation, case management, nutrition,
service plan development and review, nursing
services, and assistive technology services and
devices for dependents from birth to age three
(3) who are certified by the department of human
services as eligible for services under part C
of the Individuals with Disabilities Education Act
(20 U.S.C. section 1471 et seq.).
(b) Subject to
the annual limits provided in this section, insurers shall reimburse certified
early intervention providers, who are designated
as such by the Department of Human Services,
for early intervention services as defined in
this section at rates of reimbursement equal to or
greater than the prevailing integrated
state/Medicaid rate for early intervention services as
established by the Department of Human Services.
(c) This
section shall not apply to insurance coverage providing benefits for: (1)
hospital
confinement indemnity; (2) disability income;
(3) accident only; (4) long-term care; (5) Medicare
supplement; (6) limited benefit health; (7)
specified disease indemnity; (8) sickness or bodily
injury or death by accident or both; and (9)
other limited benefit policies.
SECTION 5. Title
27 of the General Laws entitled "Insurance" is hereby amended by
adding thereto the following chapter:
CHAPTER
69
MANDATED BENEFITS
27-69-1.
Purpose. – The purpose of this chapter is to provide for the
availability of
health plans that qualify as high deductible
health plans which may be purchased for use with a
health savings account and all similar plans
that may be tax-favored under title 26 of the United
States Code, as amended from time to time, and
under those laws of this state that provide for
taxation. This chapter shall be liberally
construed to allow employers, employees and individuals
to receive maximum tax benefits provided in
federal or state law through use of high deductibles
and other cost-sharing by a beneficiary.
27-69-2.
Definitions. – (a) "Commissioner" shall mean the director
of the department of
business regulation or the health insurance
commissioner, as appropriate.
(b)
"Health plan" shall mean "health insurance coverage" as
defined in subsections 27-
18.5-2(8)(i) and 27-18.6-2(16)(i) or
"health benefit plan" as defined in section 27-50-3.
(c) "High
deductible health plan" shall have the same meaning as defined in 26
U.S.C.
223.
(d)
"Mandated benefit law" shall mean any law of this state that requires
provision of
health insurance coverage for a specified
service or payment to a specified type of health care
provider, including, but not limited to, the benefits
or services mandated in section 27-18-48.1,27-
18-60, 27-18-62, 27-18-64, similar provisions in
title 27, chapters 19, 20 and 41, and sections 27-
18-3(c), 27-38.2-1 et seq., and all mandated
benefit laws passed subsequent to the effective date
of this chapter unless applicability of this
chapter is specifically excluded in such law.
27-69-3.
Deductibles and other cost-sharing. – Notwithstanding anything to
the
contrary in any mandated benefit law, no
mandated benefit law shall be construed to forbid
inclusion in any health plan of a provision for
any deductible and/or other cost-sharing provisions
suitable to qualify a health plan, which may be
purchased for use with health savings accounts for
a tax preference, as a high deductible health
plan or any other similar federal or state tax
preference available now or in the future;
provided, however, that this section shall not exempt
high deductible health plans from any other
provision of applicable mandated benefit laws. The
commissioner shall retain jurisdiction to
approve policies, rates and forms for all high deductible
health plans pursuant to the provisions of this
title and title 42 of the general laws.
27-69-4.
Rules and regulations. – The commissioner shall promulgate any rules
or
regulations as he or she shall deem necessary
for the efficient administration of this chapter.
27-69-5.
Severability. – If any provision of this chapter or its application
to any person
or circumstance is held invalid, the invalidity
shall not affect other provisions or applications of
this chapter which can be given effect without
the invalid provision or application, and for this
purpose the provisions of this chapter are
severable.
27-69-6.
Sunset provision. – This chapter shall be and is hereby repealed
effective July
1, 2010.
SECTION 6. The
health insurance commissioner shall provide a comprehensive report on
health savings accounts to the general assembly
prior to April 1, 2009. The report shall provide
an overview of policies that qualify as a high
deductible health plan. The report shall include, but
not be limited to, an analysis of the effect
that deductibles and co-insurance factors have had on
uninsured and underinsured populations. The
health insurance commissioner shall provide an
update of said analysis to the general assembly
prior to April 1, 2010.
SECTION 7.
Sections 1, 2, 3, 4 and 6 of this act shall take effect upon passage, section 5
of this act shall take
effect upon passage and shall be repealed effective July 1, 2010.
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LC01126/SUB
B
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