Chapter 352
2009 -- S 0471 SUBSTITUTE A AS
AMENDED
Enacted 11/13/09
A N A C T
RELATING TO
INSURANCE - ACCIDENT AND SICKNESS INSURANCE POLICIES
Introduced By: Senator James E. Doyle
Date Introduced: February 25, 2009
It is enacted by the
General Assembly as follows:
SECTION 1. Section 27-18-34 of the General Laws in Chapter
27-18 entitled "Accident
and Sickness Insurance Policies" is hereby amended
to read as follows:
27-18-34. Health
insurance contracts -- Certified registered nurse practitioners and
psychiatric and mental health nurse clinical specialists. -- (a) Every health
insurance contract,
plan, or policy delivered, issued for delivery, or renewed
in this state shall provide coverage for
the services of a certified registered nurse
practitioner, practicing collaboratively, or in the
employ of a physician licensed under chapter 37 of title 5,
and psychiatric and mental health
nurse clinical specialists, to subscribers Every health insurance contract, plan, or policy
delivered,
issued for delivery, or renewed in this state shall provide
coverage for the services of a certified
registered nurse practitioner and psychiatric and mental health
nurse clinical specialist practicing
collaboration with or in the employ of a physician licensed under
chapter 37 of title 5 to
subscribers, if the
services are within the certified registered nurse practitioner's or
psychiatric
and mental health nurse clinical specialist's area of
professional competence as established by
education and certification, and are currently reimbursed when
rendered by any other licensed
health care provider. No insurer or hospital, medical
service corporation, or health maintenance
organization may require the signature, by any other health care
provider as a condition of
reimbursement. No insurer or hospital, medical service corporation,
or health maintenance
organization may be required to pay for duplicative services
actually rendered by both a certified
registered nurse practitioner and any other health care
provider.
(b) Nothing in this
chapter shall preclude the conducting of managed care reviews and
medical necessity reviews by an insurer or hospital or
medical service corporation or health
maintenance organization.
(c) Every health
insurance contract, plan, or policy delivered, issued for delivery, or
renewed in this state shall provide coverage for certified
registered nurse practitioners to provide
primary care, intermediate, home, long-term and inpatient
care as primary care providers, when
said certified registered nurse practitioner is a
participating provider, consistent with, and
practicing within, the scope of his/her professional license.
(d) Notwithstanding
any law to the contrary, all insurers, nonprofit medical service
corporations, nonprofit hospital service corporations and health
maintenance organizations shall
provide subscribers with an opportunity to select a certified
registered nurse practitioner, who is a
participating provider, as a primary care provider.
(e) Notwithstanding
any law to the contrary, all insurers, nonprofit medical service
corporations, nonprofit hospital service corporations and health
maintenance organizations shall
insure that all participating primary care provider
certified registered nurse practitioners are
included on any publicly accessible list of participating
providers for the respective organization.
(f) 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 27-19-27 of the General Laws in Chapter
27-19 entitled "Nonprofit
Hospital Service
Corporations" is hereby amended to read as follows:
27-19-27.
Certified registered nurse practitioners and psychiatric and mental health
nurse clinical specialists. -- (a) Every health
insurance contract, plan, or policy delivered, issued
for delivery, or renewed in this state shall provide
coverage for the services of a certified
registered nurse practitioner, practicing collaboratively, or in
the employ of a physician licensed
under chapter 37 of title 5, and psychiatric and mental
health nurse clinical specialists, to
subscribers Every individual or group hospital or medical
expense insurance policy or individual
or group hospital or medical service plan contract
delivered, issued for delivery, or renewed in
this state shall provide coverage for the services of the
certified registered nurse practitioner and
psychiatric and mental health nurse clinical specialist
practicing in collaboration with or in the
employ if a physician licensed under chapter 37 of title 5
to subscribers, if the services are
within
the certified registered nurse practitioner's or
psychiatric and mental health nurse clinical
specialist's area of professional competence as established by
education and certification, and are
currently reimbursed when rendered by any other licensed health
care provider. No insurer or
hospital or medical service corporation may require signature
by any other health care provider as
a condition of reimbursement. No insurer or hospital or
medical service corporation may be
required to pay for duplicative services actually rendered by
both a certified nurse practitioner
and any other health care provider.
(b) Nothing in this
chapter shall preclude the conducting of managed care reviews and
medical necessity reviews by an insurer or hospital or
medical service corporation or health
maintenance organization.
(c) Every individual
or group hospital or medical expense insurance policy or individual
or group hospital or medical service plan contract
delivered, issued for delivery, or renewed in
this state shall provide coverage for certified registered
nurse practitioners to provide primary
care, intermediate, home, long-term and inpatient care as
primary care providers, when said
certified registered nurse practitioner is a participating
provider, consistent with, and practicing
within, the scope of his/her professional license.
(d) Notwithstanding
any law to the contrary, all insurers, nonprofit medical service
corporations, nonprofit hospital service corporations and health
maintenance organizations shall
provide subscribers with an opportunity to select a certified
registered nurse practitioner, who is a
participating provider, as a primary care provider.
(e) Notwithstanding
any law to the contrary, all insurers, nonprofit medical service
corporations, nonprofit hospital service corporations and health
maintenance organizations shall
insure that all participating primary care provider
certified registered nurse practitioners are
included on any publicly accessible list of participating
providers for the respective organization.
SECTION 3. Section 27-41-39 of the General Laws in Chapter
27-41 entitled "Health
Maintenance
Organizations" is hereby amended to read as follows:
27-41-39.
Certified registered nurse practitioners and psychiatric and mental health
nurse clinical specialists. -- (a) Every individual or
group policy or contract delivered, issued for
delivery, or renewed by a health maintenance organization in
this state shall provide coverage for
the services of certified registered nurse practitioners,
practicing collaboratively and psychiatric
and mental health nurse clinical specialists to
subscribers, if those services are within the certified
registered nurse practitioner's or psychiatric and mental health
nurse clinical specialist's area of
professional competence as established by education and
certification, and are currently
reimbursed when rendered by any other health care provider. No
health maintenance organization
may be required to pay for duplicative services actually
rendered by a certified nurse practitioner
and any other health care provider.
(b) Nothing in this
chapter shall preclude the conducting of managed care reviews and
medical necessity reviews by an insurer or hospital or
medical service corporation or health
maintenance organization.
(c) Every individual
or group policy or contract delivered, issued for delivery, or renewed
by a health maintenance organization in this state shall
provide coverage for certified registered
nurse practitioners to provide primary care, intermediate,
home, long-term and inpatient care as
primary care providers, when said certified registered nurse
practitioner is a participating
provider, consistent with, and practicing within, the scope of
his/her professional license.
(d) Notwithstanding
any law to the contrary, all insurers, nonprofit medical service
corporations, nonprofit hospital service corporations and health
maintenance organizations shall
provide subscribers with an opportunity to select a certified
registered nurse practitioner, who is a
participating provider, as a primary care provider.
(e) Notwithstanding
any law to the contrary, all insurers, nonprofit medical service
corporations, nonprofit hospital service corporations and health
maintenance organizations shall
insure that all participating primary care provider
certified registered nurse practitioners are
included on any publicly accessible list of participating
providers for the respective organization.
SECTION 4. This act shall take effect on January 1, 2010.
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LC01896/SUB A
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