2016 -- H 7618 SUBSTITUTE A

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LC004755/SUB A

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2016

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A N   A C T

RELATING TO INSURANCE - HEALTH INSURANCE

     

     Introduced By: Representatives Bennett, Solomon, Naughton, Azzinaro, and

     Date Introduced: February 12, 2016

     Referred To: House Corporations

     It is enacted by the General Assembly as follows:

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     SECTION 1. Section 27-18-55 of the General Laws in Chapter 27-18 entitled "Accident

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

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     27-18-55. Acupuncture services. -- Acupuncture and Oriental medicine services. --

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

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renewed in this state which provides medical coverage, and every group policy which provides

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for treatment of persons for the prevention, cure or correction of any illness or physical or mental

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condition, shall provide, as an optional rider, coverage for the services, within the scope of

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practice, of a doctor of acupuncture and Oriental medicine licensed under chapter 37.2 of title 5

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as a provider of acupuncture services; provided, that this section shall not apply to insurance

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coverage providing benefits for: (1) hospital confinement indemnity; (2) disability income; (3)

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accident only; (4) long term care; (5) Medicare supplement; (6) limited benefit health; (7)

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specified disease indemnity; (8) sickness or bodily injury or death by accident or both; and (9)

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other limited benefit policies.

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      (b) For the purposes of this section:

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     (1) "Doctor of acupuncture" means a practitioner licensed under chapter 37.2 of title 5.

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     (2) "Coverage for the services of a doctor of acupuncture as a provider of acupuncture

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services" means coverage for acupuncture as defined in § 5-37.2-2(1).

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      (c)(b) It shall remain within the sole discretion of the accident and sickness insurer as to

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which doctor of acupuncture and Oriental medicine it shall contract with. Reimbursement shall be

 

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provided according to the respective principles and policies of the accident and sickness insurer;

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provided, that no accident and sickness insurer may be required to pay for duplicative services

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actually rendered by a doctor of acupuncture and Oriental medicine and any other health care

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provider. Nothing contained in this section shall preclude the accident and sickness insurer from

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conducting managed care, medical necessity or utilization review.

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

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

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

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

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

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

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

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establishing varying reimbursement rates based on quality or performance measures.

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     SECTION 2. Section 27-19-47 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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     27-19-47. Acupuncture services. -- Acupuncture and Oriental medicine services. --

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

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renewed in this state which provides medical coverage, and every group policy which provides

19

for treatment of persons for the prevention, cure or correction of any illness or physical or mental

20

condition, shall provide, as an optional rider, coverage for the services, within the scope of

21

practice, of a doctor of acupuncture and Oriental medicine licensed under chapter 37.2 of title 5

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as a provider of acupuncture services.

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      (b) For the purposes of this section:

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      (1) "Doctor of acupuncture" means a practitioner licensed under chapter 37.2 of title 5.

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      (2) "Coverage for the services of a doctor of acupuncture as a provider of acupuncture

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services" means coverage for acupuncture as defined in § 5-37.2-2(1).

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      (c)(b) It remains within the sole discretion of the non-profit hospital service corporation

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as to which doctor of acupuncture and Oriental medicine it shall contract with. Reimbursement is

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provided according to the respective principles and policies of the non-profit hospital service

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corporation; provided, that no non-profit hospital service corporation is required to pay for

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duplicative services actually rendered by a doctor of acupuncture and Oriental medicine and any

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other health care provider. Nothing contained in this section precludes the non-profit hospital

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

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

 

LC004755/SUB A - Page 2 of 5

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

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

3

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

4

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

5

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

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

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establishing varying reimbursement rates based on quality or performance measures.

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     SECTION 3. Section 27-20-42 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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     27-20-42. Acupuncture services. -- Acupuncture and Oriental medicine services. --

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

12

delivery or renewed in this state which provides medical coverage, and every group policy which

13

provides for treatment of persons for the prevention, cure or correction of any illness or physical

14

or mental condition shall provide, as an optional rider, coverage for the services, within the scope

15

of practice, of a doctor of acupuncture and Oriental medicine licensed under chapter 37.2 of title

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5 as a provider of acupuncture services.

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      (b) For the purposes of this section:

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      (1) "Doctor of acupuncture" means a practitioner licensed under chapter 37.2 of title 5.

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      (2) "Coverage for the services of a doctor of acupuncture as a provider of acupuncture

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services" means coverage for acupuncture as defined in § 5-37.2-2(1).

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      (c)(b) It remains within the sole discretion of the non-profit medical service corporation

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as to which doctor of acupuncture and Oriental medicine it contracts with. Reimbursement is

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provided according to the respective principles and policies of the non-profit medical service

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corporation; provided, that no non-profit medical service corporation may be required to pay for

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duplicative services actually rendered by a doctor of acupuncture and Oriental medicine and any

26

other health care provider. Nothing contained in this section precludes non-profit medical service

27

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

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

29

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

30

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

31

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

32

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

33

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

34

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

 

LC004755/SUB A - Page 3 of 5

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establishing varying reimbursement rates based on quality or performance measures.

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     SECTION 4. Section 27-41-57 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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     27-41-57. Acupuncture services. -- Acupuncture sand Oriental medicine services. --

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

6

delivery or renewed in this state which provides medical coverage, and every group policy which

7

provides for treatment of persons for the prevention, cure or correction of any illness or physical

8

or mental condition shall provide, as an optional rider, coverage for the services, within the scope

9

of practice, of a doctor of acupuncture and Oriental medicine licensed under chapter 37.2 of title

10

5 as a provider of acupuncture services.

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      (b) For the purposes of this section:

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      (1) "Doctor of acupuncture" means a practitioner licensed under chapter 37.2 of title 5.

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      (2) "Coverage for the services of a doctor of acupuncture as a provider of acupuncture

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services" means coverage for acupuncture as defined in section 5-37.2-2(1).

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      (c)(b) It remains within the sole discretion of the health maintenance organization as to

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which doctor of acupuncture and Oriental medicine it contracts with. Reimbursement is provided

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according to the respective principles and policies of the health maintenance organization;

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provided, that no health maintenance organization is required to pay for duplicative services

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actually rendered by a doctor of acupuncture and Oriental medicine and any other health care

20

provider. Nothing contained in this section precludes the health maintenance organization from

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conducting managed care, medical necessity or utilization review.

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

23

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

24

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

25

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

26

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

27

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

28

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

29

establishing varying reimbursement rates based on quality or performance measures.

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     SECTION 5. This act shall take effect on January 1, 2017.

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LC004755/SUB A - Page 4 of 5

EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE - HEALTH INSURANCE

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     This act would prohibit health insurance insurers from discriminating against any health

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care provider, who is acting within the scope of their license or certification, concerning

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participation and coverage in their plan.

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     This act would take effect on January 1, 2017.

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LC004755/SUB A

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LC004755/SUB A - Page 5 of 5