Chapter 099 |
2019 -- H 5401 Enacted 07/08/2019 |
A N A C T |
RELATING TO STATE AFFAIRS AND GOVERNMENT -- THE HEALTH CARE SERVICES FUNDING PLAN ACT |
Introduced By: Representatives Bennett, Edwards, Solomon, and Diaz |
Date Introduced: February 14, 2019 |
It is enacted by the General Assembly as follows: |
SECTION 1. Section 42-7.4-2 of the General Laws in Chapter 42-7.4 entitled "The |
Health Care Services Funding Plan Act" is hereby amended to read as follows: |
42-7.4-2. Definitions. |
The following words and phrases as used in this chapter shall have the following |
meaning: |
(1)(5) "Secretary" means the secretary of health and human services. |
(2)(3)(i) "Insurer" means all persons offering, administering, and/or insuring healthcare |
services, including, but not limited to: |
(A) Policies of accident and sickness insurance, as defined by chapter 18 of title 27: |
(B) Nonprofit hospital or medical-service plans, as defined by chapters 19 and 20 of title |
27; |
(C) Any person whose primary function is to provide diagnostic, therapeutic, or |
preventive services to a defined population on the basis of a periodic premium; |
(D) All domestic, foreign, or alien insurance companies, mutual associations, and |
organizations; |
(E) Health maintenance organizations, as defined by chapter 41 of title 27; |
(F) All persons providing health benefits coverage on a self-insurance basis; |
(G) All third-party administrators described in chapter 20.7 of title 27; and |
(H) All persons providing health benefit coverage under Title XIX of the Social Security |
Act (Medicaid) as a Medicaid managed care organization offering managed Medicaid. |
(ii) "Insurer" shall not include any nonprofit dental service corporation as defined in § 27- |
20.1-2, nor any insurer offering only those coverages described in § 42-7.4-14. |
(3)(1)(i) "Contribution enrollee" means an individual residing in this state, with respect to |
whom an insurer administers, provides, pays for, insures, or covers health-care healthcare |
services, unless excepted by this section. |
(ii) "Contribution enrollee" shall not include an individual whose healthcare services are |
paid or reimbursed by Part A or Part B of the Medicare program, a Medicare supplemental policy |
as defined in section 1882(g)(1) of the Social Security Act, 42 U.S.C. § 1395ss(g)(1), or Medicare |
managed care policy, the federal employees' health benefit program, Tricare, CHAMPUS, the |
Veterans' healthcare program, the Indian health service program, or any local governmental |
corporation, district, or agency providing health benefits coverage on a self-insured basis; |
(iii) Delayed applicability for state employees, retirees, and dependents and not-for-profit |
healthcare corporations. An individual whose healthcare services are paid or reimbursed by the |
state of Rhode Island pursuant to chapter 12 of title 36 or a not-for-profit healthcare corporation |
that controls or operates hospitals licensed under chapter 17 of title 23 or a not-for-profit |
healthcare corporation that controls or operates hospitals licensed under chapter 17 of title 23, and |
facilities and programs providing rehabilitation, psychological support, and social guidance to |
individuals who are alcoholic, drug abusers, mentally ill, or who are persons with developmental |
disabilities or cognitive disabilities, such as brain injury, licensed under chapter 24 of title 40.1 |
shall not be treated as a "contribution enrollee" until July 1, 2016. |
(4) "Person" means any individual, corporation, company, association, partnership, |
limited liability company, firm, state governmental corporations, districts, and agencies, joint |
stock associations, trusts, and the legal successor thereof. |
(5)(2) "Healthcare services funding contribution" means per capita amount each |
contributing insurer must contribute to support the programs funded by the method established |
under this section, with respect to each contribution enrollee; provided, however, that, with |
respect to an insurer that is a Medicaid managed care organization offering managed Medicaid, |
the healthcare funding services contribution for any contribution enrollee whose healthcare |
services are paid or reimbursed under Title XIX of the Social Security Act (Medicaid) shall not |
include the children's health services funding requirement described in § 42-12-29. |
SECTION 2. This act shall take effect upon passage. |
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LC001398 |
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