§ 27-20.10-2. Scope.
(a) This chapter shall apply to health insurance corporations subject to chapter 1 of this title, nonprofit hospital or medical service corporations subject to chapter 19 or 20 of this title, and health maintenance organizations incorporated or resident in the state of Rhode Island.
(b) This chapter shall not apply to provider network contracts for services provided to Medicaid, Medicare, or state children’s health insurance program (SCHIP) beneficiaries.
(c) This chapter shall not apply in circumstances where access to the provider network contract is granted to an entity operating under common control with or under the same brand licensee program as the contracting entity (“affiliate entities”). Contracting entities shall, however, make the list of such affiliate entities available on a website or by other means. The affiliate entities shall have the same rights and responsibilities under the provider network contracts as the contracting entities.
(d) This chapter shall not apply to a contract between a contracting entity and a discount medical plan organization.
(e) This chapter shall not apply to any entity, such as employers, church plans, or government plans, receiving administrative services from the contracting entity or an affiliate entity. Such exempt entities shall have the same rights and responsibilities under the provider network contracts as the contracting entities, except the exempt entities shall not grant access to a provider’s healthcare services and contractual discounts to any other entity.
History of Section.
P.L. 2009, ch. 190, § 1; P.L. 2009, ch. 209, § 1.