2015 -- H 5046

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LC000174

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2015

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A N   A C T

RELATING TO INSURANCE - HEALTH INSURANCE

     

     Introduced By: Representatives McNamara, Azzinaro, Shekarchi, Corvese, and Malik

     Date Introduced: January 08, 2015

     Referred To: House Health, Education & Welfare

     It is enacted by the General Assembly as follows:

1

     SECTION 1. Section 27-18-48 of the General Laws in Chapter 27-18 entitled "Accident

2

and Sickness Insurance Policies" is hereby amended to read as follows:

3

     27-18-48. Third party reimbursement for services of certain health care workers. --

4

(a) Every individual or group hospital or medical services plan contract delivered, issued or

5

renewed by an insurer or nonprofit or for profit health service corporation which provides

6

benefits to individual subscribers and members within the state, or to all group members having a

7

principal place of employment within the state, shall provide benefits for services rendered by a

8

certified registered nurse anesthetist designated as a certified registered nurse anesthetist by the

9

board of nurse registration and nursing education; provided, that the following conditions are met:

10

      (1) The certified registered nurse anesthetist provides certain health care services under

11

the supervision of anesthesiologists, licensed physicians or licensed dentists in accordance with

12

section 5-34.2-2(c), which requires substantial specialized knowledge, judgment and skill related

13

to the administration of anesthesia, including pre-operative and post-operative assessment of

14

patients; administering anesthetics; monitoring patients during anesthesia; management of fluids

15

in intravenous therapy and management of respiratory care; The certified registered nurse

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anesthetist adheres to the practice of certified registered nurse anesthesia as defined by and in

17

accordance with § 5-34.2-2.

18

      (2) The policy or contract currently provides benefits for identical services rendered by a

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provider of health care licensed by the state; and

 

1

      (3) The certified registered nurse anesthetist is not a salaried employee of the licensed

2

hospital or facility for which the accident and sickness insurer has an alternative contractual

3

relationship to fund the services of a certified registered nurse anesthetist.

4

      (b) It shall remain within the sole discretion of the health maintenance organization as to

5

which certified registered nurse anesthetists it shall contract with. Reimbursement shall be

6

provided according to the respective principles and policies of the health maintenance

7

organization; provided, that no health maintenance organization may be required to pay for

8

duplicative services actually rendered by a certified registered nurse anesthetist and any other

9

health care provider. Nothing contained in this section shall preclude the health maintenance

10

organization from conducting managed care, medical necessity or utilization review.

11

     (c) Providers. -- A group health plan and a health insurance issuer offering group or

12

individual health insurance coverage shall not discriminate with respect to participation under the

13

plan or coverage against any health care provider who is acting within the scope of that provider's

14

license or certification under applicable state law. This section shall not require that a group

15

health plan or health insurance issuer contract with any health care provider willing to abide by

16

the terms and conditions for participation established by the plan or issuer. Nothing in this section

17

shall be construed as preventing a group health plan, or a health insurance issuer, from

18

establishing varying reimbursement rates based on quality or performance measures.

19

     SECTION 2. Section 27-19-40 of the General Laws in Chapter 27-19 entitled "Nonprofit

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Hospital Service Corporations" is hereby amended to read as follows:

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     27-19-40. Third party reimbursement for services of certain health care workers. --

22

(a) Every individual or group health insurance contract, plan or policy delivered, issued or

23

renewed by an insurer or nonprofit or for profit health service corporation which provides

24

benefits to individual subscribers and members within the state, or to all group members having a

25

principal place of employment within the state, shall provide benefits for services rendered by a

26

certified registered nurse anesthetist designated as a certified registered nurse anesthetist by the

27

board of nurse registration and nursing education; provided, that the following conditions are met:

28

      (1) The certified registered nurse anesthetist provides certain health care services under

29

the supervision of anesthesiologists, licensed physicians or licensed dentists in accordance with

30

section 5-34.2-2(c), which requires substantial specialized knowledge, judgment and skill related

31

to the administration of anesthesia, including pre-operative and post-operative assessment of

32

patients; administering anesthetics, monitoring patients during anesthesia; management of fluids

33

in intravenous therapy and management of respiratory care; adheres to the practice of certified

34

registered nurse anesthesia as defined by and in accordance with § 5-34.2-2.

 

LC000174 - Page 2 of 6

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      (2) The policy or contract currently provides benefits for identical services rendered by a

2

provider of health care licensed by the state; and

3

      (3) The certified registered nurse anesthetist is not a salaried employee of the licensed

4

hospital or facility for which the nonprofit hospital service corporation has an alternative

5

contractual relationship to fund the services of a certified registered nurse anesthetist.

6

      (b) It shall remain within the sole discretion of the nonprofit hospital service corporation

7

as to which certified registered nurse anesthetists it shall contract with. Reimbursement shall be

8

provided according to the respective principles and policies of the nonprofit hospital service

9

corporation; provided, that no nonprofit hospital service corporation may be required to pay for

10

duplicative services actually rendered by a certified registered nurse anesthetist and any other

11

health care provider. Nothing contained in this section shall preclude the nonprofit hospital

12

service corporation from conducting managed care, medical necessity or utilization review.

13

     (c) Providers. -- A group health plan and a health insurance issuer offering group or

14

individual health insurance coverage shall not discriminate with respect to participation under the

15

plan or coverage against any health care provider who is acting within the scope of that provider's

16

license or certification under applicable state law. This section shall not require that a group

17

health plan or health insurance issuer contract with any health care provider willing to abide by

18

the terms and conditions for participation established by the plan or issuer. Nothing in this section

19

shall be construed as preventing a group health plan, or a health insurance issuer, from

20

establishing varying reimbursement rates based on quality or performance measures.

21

     SECTION 3. Section 27-20-35 of the General Laws in Chapter 27-20 entitled "Nonprofit

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Medical Service Corporations" is hereby amended to read as follows:

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     27-20-35. Third party reimbursement for services of certain health care workers. --

24

(a) Every individual or group health insurance contract, plan or policy delivered, issued or

25

renewed by an insurer or nonprofit or for profit health service corporation which provides

26

benefits to individual subscribers and members within the state, or to all group members having a

27

principal place of employment within the state, shall provide benefits for services rendered by a

28

certified registered nurse anesthetist designated as a certified registered nurse anesthetist by the

29

board of nurse registration and nursing education; provided, that the following conditions are met:

30

      (1) The certified registered nurse anesthetist provides certain health care services under

31

the supervision of anesthesiologists, licensed physicians or licensed dentists in accordance with

32

section 5-34.2-2(c), which requires substantial specialized knowledge, judgment and skill related

33

to the administration of anesthesia, including pre-operative and post-operative assessment of

34

patients; administering anesthetics; monitoring patients during anesthesia; management of fluids

 

LC000174 - Page 3 of 6

1

in intravenous therapy and management of respiratory care; adheres to the practice of certified

2

registered nurse anesthesia as defined by and in accordance with § 5-34.2-2.

3

      (2) The policy or contract currently provides benefits for identical services rendered by a

4

provider of health care licensed by the state; and

5

      (3) The certified registered nurse anesthetist is not a salaried employee of the licensed

6

hospital or facility for which the nonprofit medical service corporation has an alternative

7

contractual relationship to fund the services of a certified registered nurse anesthetist.

8

      (b) It shall remain within the sole discretion of the nonprofit medical service corporation

9

as to which certified registered nurse anesthetists it shall contract with. Reimbursement shall be

10

provided according to the respective principles and policies of the nonprofit medical service

11

corporation; provided, that no nonprofit medical service corporation may be required to pay for

12

duplicative services actually rendered by a certified registered nurse anesthetist and any other

13

health care provider. Nothing contained in this section shall preclude the nonprofit medical

14

service corporation from conducting managed care, medical necessity or utilization review.

15

     (c) Providers. -- A group health plan and a health insurance issuer offering group or

16

individual health insurance coverage shall not discriminate with respect to participation under the

17

plan or coverage against any health care provider who is acting within the scope of that provider's

18

license or certification under applicable state law. This section shall not require that a group

19

health plan or health insurance issuer contract with any health care provider willing to abide by

20

the terms and conditions for participation established by the plan or issuer. Nothing in this section

21

shall be construed as preventing a group health plan, or a health insurance issuer, from

22

establishing varying reimbursement rates based on quality or performance measures.

23

     SECTION 4. Section 27-41-49 of the General Laws in Chapter 27-41 entitled "Health

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Maintenance Organizations" is hereby amended to read as follows:

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     27-41-49. Third party reimbursement for services of certain health care workers. --

26

(a) Every individual or group health insurance contract, plan or policy delivered, issued or

27

renewed by an insurer, health maintenance organization, nonprofit or for profit health service

28

corporation which provides benefits to individual subscribers and members within the state, or to

29

all group members having a principal place of employment within the state, shall provide benefits

30

for services rendered by a certified registered nurse anesthetist designated as a certified registered

31

nurse anesthetist by the board of nurse registration and nursing education; provided, that the

32

following conditions are met:

33

      (1) The certified registered nurse anesthetist provides certain health care services under

34

the supervision of anesthesiologists, licensed physicians or licensed dentists in accordance with

 

LC000174 - Page 4 of 6

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section 5-34.2-2(c), which requires substantial specialized knowledge, judgment and skill related

2

to the administration of anesthesia, including pre-operative and post-operative assessment of

3

patients; administering anesthetics; monitoring patients during anesthesia; management of fluids

4

in intravenous therapy and management of respiratory care; adheres to the practice of certified

5

registered nurse anesthesia as defined by and in accordance with § 5-34.2-2.

6

      (2) The policy or contract currently provides benefits for identical services rendered by a

7

provider of health care licensed by the state; and

8

      (3) The certified registered nurse anesthetist is not a salaried employee of the licensed

9

hospital or facility for which the health maintenance organization has an alternative contractual

10

relationship to fund the services of a certified registered nurse anesthetist.

11

      (b) It shall remain within the sole discretion of the health maintenance organization as to

12

which certified registered nurse anesthetists it shall contract with. Reimbursement shall be

13

provided according to the respective principles and policies of the health maintenance

14

organization; provided, that no health maintenance organization may be required to pay for

15

duplicative services actually rendered by a certified registered nurse anesthetist and any other

16

health care provider. Nothing contained in this section shall preclude the health maintenance

17

organization from conducting managed care, medical necessity or utilization review.

18

     (c) Providers. -- A group health plan and a health insurance issuer offering group or

19

individual health insurance coverage shall not discriminate with respect to participation under the

20

plan or coverage against any health care provider who is acting within the scope of that provider's

21

license or certification under applicable state law. This section shall not require that a group

22

health plan or health insurance issuer contract with any health care provider willing to abide by

23

the terms and conditions for participation established by the plan or issuer. Nothing in this section

24

shall be construed as preventing a group health plan, or a health insurance issuer, from

25

establishing varying reimbursement rates based on quality or performance measures.

26

     SECTION 5. This act shall take effect upon passage.

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LC000174

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LC000174 - Page 5 of 6

EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE - HEALTH INSURANCE

***

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     This act would prohibit a group health plan and a health insurance issuer from

2

discriminating with respect to participation under the plan or coverage against any health care

3

provider who is acting within the scope of that provider's license or certification under applicable

4

state law.

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     This act would take effect upon passage.

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LC000174

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LC000174 - Page 6 of 6