Chapter
086
2007 -- H 5736 SUBSTITUTE B
Enacted 06/22/07
A N A C T
RELATING
TO INSURANCE -- HEALTH MAINTENANCE ORGANIZATIONS
Introduced
By: Representatives Lewiss, Handy, Kennedy, Shanley, and San Bento
Date
Introduced: February 28, 2007
It is enacted by the General Assembly as
follows:
SECTION 1. Title
27 of the General Laws entitled "INSURANCE" is hereby amended
by adding thereto the following chapter:
CHAPTER
20.9
CONTRACT WITH HEALTH
CARE PROVIDERS
27-20.9-1.
Health care contracts – Required provisions - Definitions – (a) On
and
after January 1, 2008, a health insurer that
contracts with a health care provider shall comply with
the provisions of this chapter and shall include
the provisions required by this chapter in the
health care contract. A contract in existence
prior to January 1, 2008, that is renewed or renews
by its terms shall comply with the provisions of
this chapter no later than December 31, 2008.
(b) As used in
this chapter, unless the context otherwise requires:
(i) “Health care
contract” means a contract entered into or renewed between a health
insurer and a health care provider for the
delivery of health care services to others.
(ii) “Health
care provider” means a person licensed or certified in this state to practice
medicine, pharmacy, chiropractic, nursing,
physical therapy, podiatry, dentistry, optometry,
occupational therapy, or other healing arts.
(iii) “Health
insurer” means every nonprofit medical service corporation, hospital service
corporation, health maintenance organization, or
other insurer offering and/or insuring health
services; the term shall in addition include any
entity defined as an insurer under section 42-62-4
and any third-party administrator when interacting
with health care providers and enrollees on
behalf of such an insurer.
27-20.9-2.
Credentialing -- Insurers shall notify providers of initial credentialing
within ten business days of approval by the
insurer credentialing committee. – The health
insurer shall reimburse the health care provider
for covered services rendered by the health care
provider to the health insurer's subscribers or
members following the first business day after the
credentialing committee's approval, provided that
the health care provider returns a signed health
care contract within fifteen (15) business days
of receipt from the health insurer.
27-20.9-3.
Pay-for-performance guidelines. – A health insurer shall not require
a
physician, as a condition of contracting, to
participate in any financial or reimbursement incentive
program, commonly referred to as
pay-for-performance programs unless such program meets the
principles and guidelines for
pay-for-performance programs endorsed by the national quality
forum and adopted by the AQA Alliance or the
hospital quality alliance, or similar principles and
guidelines for pay-for-performance programs
approved by the office of the health insurance
commissioner.
SECTION 2. This
act shall take effect upon passage.
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LC01300/SUB B
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