2015 -- H 5702 SUBSTITUTE A

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LC001561/SUB A

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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 - ACCIDENT AND SICKNESS INSURANCE POLICIES

     

     Introduced By: Representative Raymond H. Johnston

     Date Introduced: February 26, 2015

     Referred To: House Corporations

     It is enacted by the General Assembly as follows:

1

     SECTION 1. Chapter 27-18 of the General Laws entitled "Accident and Sickness

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Insurance Policies" is hereby amended by adding thereto the following section:

3

     27-18-34.1. Health insurance contracts – Pharmacists. – (a) Every health insurance

4

contract, plan, or policy delivered, issued for delivery, or renewed in this state shall provide

5

coverage for the services of a pharmacist practicing collaboratively, or in the employ of a

6

pharmacist or pharmacy licensed under chapter 19.1 of title 5, to subscribers if the services are

7

within the pharmacist's area of professional competence as established by education and

8

certification, and are currently reimbursed when rendered by any other licensed health care

9

provider. No insurer or hospital, medical service corporation, or health maintenance organization

10

may require the signature, by any other health care provider as a condition of reimbursement. No

11

insurer or hospital, medical service corporation, or health maintenance organization may be

12

required to pay for duplicative services actually rendered by both a pharmacist and any other

13

health care provider.

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     (b) Nothing in this chapter shall preclude the conducting of managed care reviews and

15

medical necessity reviews by an insurer or hospital, medical service corporation or health

16

maintenance organization.

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     (c) This section shall not apply to insurance coverage providing benefits for; (1) Hospital

18

confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care; (5)

19

Medicare supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or

 

1

bodily injury or death by accident or both; and (9) Other limited benefit policies.

2

     SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service

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Corporations" is hereby amended by adding thereto the following section:

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     27-19-27.1. Health insurance contracts - Pharmacists. -- (a) Every health insurance

5

contract, plan, or policy delivered, issued for delivery, or renewed in this state shall provide

6

coverage for the services of a pharmacist practicing collaboratively, or in the employ of a

7

pharmacist or pharmacy licensed under chapter 19.1 of title 5, to subscribers if the services are

8

within the pharmacist's area of professional competence as established by education and

9

certification, and are currently reimbursed when rendered by any other licensed health care

10

provider. No insurer or hospital, medical service corporation, or health maintenance organization

11

may require the signature, by any other health care provider as a condition of reimbursement. No

12

insurer or hospital, medical service corporation, or health maintenance organization may be

13

required to pay for duplicative services actually rendered by both a pharmacist and any other

14

health care provider.

15

     (b) Nothing in this chapter shall preclude the conducting of managed care reviews and

16

medical necessity reviews by an insurer or hospital, medical service corporation or health

17

maintenance organization.

18

     (c) This section shall not apply to insurance coverage providing benefits for: (1) Hospital

19

confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care; (5)

20

Medicare supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or

21

bodily injury or death by accident or both; and (9) Other limited benefit policies.

22

     SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service

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Corporations" is hereby amended by adding thereto the following section:

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     27-20-35.2. Third-party reimbursement for services of Pharmacist's. -- (a) Every

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health insurance contract, plan, or policy delivered, issued for delivery, or renewed in this state

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shall provide coverage for the services of a pharmacist, practicing collaboratively, or in the

27

employ of a pharmacist or pharmacy licensed under chapter 19.1 of title 5, to subscribers if the

28

services are within the pharmacist's area of professional competence as established by education

29

and certification, and are currently reimbursed when rendered by any other licensed health care

30

provider. No insurer or hospital, medical service corporation, or health maintenance organization

31

may require the signature, by any other health care provider as a condition of reimbursement. No

32

insurer or hospital, medical service corporation, or health maintenance organization may be

33

required to pay for duplicative services actually rendered by both a pharmacist and any other

34

health care provider.

 

LC001561/SUB A - Page 2 of 5

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     (b) Nothing in this chapter shall preclude the conducting of managed care reviews and

2

medical necessity reviews by an insurer or hospital, medical service corporation or health

3

maintenance organization.

4

     (c) This section shall not apply to insurance coverage providing benefits for: (1) Hospital

5

confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care; (5)

6

Medicare supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or

7

bodily injury or death by accident or both; and (9) Other limited benefit policies.

8

     SECTION 4. Chapter 27-20.1 of the General Laws entitled "Nonprofit Dental Service

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Corporations" is hereby amended by adding thereto the following section:

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     27-20.1-9.1. Health insurance contracts – Pharmacists. -- (a) Every health insurance

11

contract, plan, or policy delivered, issued for delivery, or renewed in this state shall provide

12

coverage for the services of a pharmacist, practicing collaboratively, or in the employ of a

13

pharmacist or pharmacy licensed under chapter 19.1 of title 5, to subscribers if the services are

14

within the pharmacist's area of professional competence as established by education and

15

certification, and are currently reimbursed when rendered by any other licensed health care

16

provider. No insurer or hospital, medical service corporation, or health maintenance organization

17

may require the signature, by any other health care provider as a condition of reimbursement. No

18

insurer or hospital, medical service corporation, or health maintenance organization may be

19

required to pay for duplicative services actually rendered by both a pharmacist and any other

20

health care provider.

21

     (b) Nothing in this chapter shall preclude the conducting of managed care reviews and

22

medical necessity reviews by an insurer or hospital, medical service corporation or health

23

maintenance organization.

24

     (c) This section shall not apply to insurance coverage providing benefits for: (1) Hospital

25

confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care; (5)

26

Medicare supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or

27

bodily injury or death by accident or both; and (9) Other limited benefit policies.

28

     SECTION 5. Chapter 27-41 of the General Laws entitled "Health Maintenance

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Organizations" is hereby amended by adding thereto the following section:

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     27-41-40.1. Health insurance contracts - Pharmacists. -- (a) Every health insurance

31

contract, plan, or policy delivered, issued for delivery, or renewed in this state shall provide

32

coverage for the services of a pharmacist, practicing collaboratively, or in the employ of a

33

pharmacist or pharmacy licensed under chapter 19.1 of title 5, to subscribers if the services are

34

within the pharmacist's area of professional competence as established by education and

 

LC001561/SUB A - Page 3 of 5

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certification, and are currently reimbursed when rendered by any other licensed health care

2

provider. No insurer or hospital, medical service corporation, or health maintenance organization

3

may require the signature, by any other health care provider as a condition of reimbursement. No

4

insurer or hospital, medical service corporation, or health maintenance organization may be

5

required to pay for duplicative services actually rendered by both a pharmacist and any other

6

health care provider.

7

     (b) Nothing in this chapter shall preclude the conducting of managed care reviews and

8

medical necessity reviews by an insurer or hospital, medical service corporation or health

9

maintenance organization.

10

     (c) This section shall not apply to insurance coverage providing benefits for: (1) Hospital

11

confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care; (5)

12

Medicare supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or

13

bodily injury or death by accident or both; and (9) Other limited benefit policies.

14

     SECTION 6. This act shall take effect upon passage.

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LC001561/SUB A - Page 4 of 5

EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE - ACCIDENT AND SICKNESS INSURANCE POLICIES

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     This act would require all health insurance contracts, plans, or policies to provide

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coverage for the services of pharmacists.

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     This act would take effect upon passage.

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