Chapter 351

2009 -- H 5537 SUBSTITUTE A

Enacted 11/13/09

A N A C T

RELATING TO INSURANCE - ACCIDENT AND SICKNESS INSURANCE POLICIES

Introduced By: Representatives Dennigan, Mattiello, and McNamara

Date Introduced: February 25, 2009

It is enacted by the General Assembly as follows:

SECTION 1. Section 27-18-34 of the General Laws in Chapter 27-18 entitled "Accident

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

27-18-34. Health insurance contracts -- Certified registered nurse practitioners and

psychiatric and mental health nurse clinical specialists. -- (a) Every health insurance contract,

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

the services of a certified registered nurse practitioner, practicing collaboratively, or in the

employ of a physician licensed under chapter 37 of title 5, and psychiatric and mental health

nurse clinical specialists, to subscribers Every health insurance contract, plan, or policy delivered,

issued for delivery, or renewed in this state shall provide coverage for the services of a certified

registered nurse practitioner and psychiatric and mental health nurse clinical specialist practicing

collaboration with or in the employ of a physician licensed under chapter 37 of title 5 to

subscribers, if the services are within the certified registered nurse practitioner's or psychiatric

and mental health nurse clinical specialist's area of professional competence as established by

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

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

organization may require the signature, by any other health care provider as a condition of

reimbursement. No insurer or hospital, medical service corporation, or health maintenance

organization may be required to pay for duplicative services actually rendered by both a certified

registered nurse practitioner and any other health care provider.

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

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

maintenance organization.

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

renewed in this state shall provide coverage for certified registered nurse practitioners to provide

primary care, intermediate, home, long-term and inpatient care as primary care providers, when

said certified registered nurse practitioner is a participating provider, consistent with, and

practicing within, the scope of his/her professional license.

(d) Notwithstanding any law to the contrary, all insurers, nonprofit medical service

corporations, nonprofit hospital service corporations and health maintenance organizations shall

provide subscribers with an opportunity to select a certified registered nurse practitioner, who is a

participating provider, as a primary care provider.

(e) Notwithstanding any law to the contrary, all insurers, nonprofit medical service

corporations, nonprofit hospital service corporations and health maintenance organizations shall

insure that all participating primary care provider certified registered nurse practitioners are

included on any publicly accessible list of participating providers for the respective organization.

(f) this section shall not apply to insurance coverage providing benefits for; (1) Hospital

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

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

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

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

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

27-19-27. Certified registered nurse practitioners and psychiatric and mental health

nurse clinical specialists. -- (a) Every health insurance contract, plan, or policy delivered, issued

for delivery, or renewed in this state shall provide coverage for the services of a certified

registered nurse practitioner, practicing collaboratively, or in the employ of a physician licensed

under chapter 37 of title 5, and psychiatric and mental health nurse clinical specialists, to

subscribers Every individual or group hospital or medical expense insurance policy or individual

or group hospital or medical service plan contract delivered, issued for delivery, or renewed in

this state shall provide coverage for the services of the certified registered nurse practitioner and

psychiatric and mental health nurse clinical specialist practicing in collaboration with or in the

employ if a physician licensed under chapter 37 of title 5 to subscribers, if the services are within

the certified registered nurse practitioner's or psychiatric and mental health nurse clinical

specialist's area of professional competence as established by education and certification, and are

currently reimbursed when rendered by any other licensed health care provider. No insurer or

hospital or medical service corporation may require signature by any other health care provider as

a condition of reimbursement. No insurer or hospital or medical service corporation may be

required to pay for duplicative services actually rendered by both a certified nurse practitioner

and any other health care provider.

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

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

maintenance organization.

(c) Every individual or group hospital or medical expense insurance policy or individual

or group hospital or medical service plan contract delivered, issued for delivery, or renewed in

this state shall provide coverage for certified registered nurse practitioners to provide primary

care, intermediate, home, long-term and inpatient care as primary care providers, when said

certified registered nurse practitioner is a participating provider, consistent with, and practicing

within, the scope of his/her professional license.

(d) Notwithstanding any law to the contrary, all insurers, nonprofit medical service

corporations, nonprofit hospital service corporations and health maintenance organizations shall

provide subscribers with an opportunity to select a certified registered nurse practitioner, who is a

participating provider, as a primary care provider.

(e) Notwithstanding any law to the contrary, all insurers, nonprofit medical service

corporations, nonprofit hospital service corporations and health maintenance organizations shall

insure that all participating primary care provider certified registered nurse practitioners are

included on any publicly accessible list of participating providers for the respective organization.

SECTION 3. Section 27-41-39 of the General Laws in Chapter 27-41 entitled "Health

Maintenance Organizations" is hereby amended to read as follows:

27-41-39. Certified registered nurse practitioners and psychiatric and mental health

nurse clinical specialists. -- (a) Every individual or group policy or contract delivered, issued for

delivery, or renewed by a health maintenance organization in this state shall provide coverage for

the services of certified registered nurse practitioners, practicing collaboratively and psychiatric

and mental health nurse clinical specialists to subscribers, if those services are within the certified

registered nurse practitioner's or psychiatric and mental health nurse clinical specialist's area of

professional competence as established by education and certification, and are currently

reimbursed when rendered by any other health care provider. No health maintenance organization

may be required to pay for duplicative services actually rendered by a certified nurse practitioner

and any other health care provider.

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

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

maintenance organization.

(c) Every individual or group policy or contract delivered, issued for delivery, or renewed

by a health maintenance organization in this state shall provide coverage for certified registered

nurse practitioners to provide primary care, intermediate, home, long-term and inpatient care as

primary care providers, when said certified registered nurse practitioner is a participating

provider, consistent with, and practicing within, the scope of his/her professional license.

(d) Notwithstanding any law to the contrary, all insurers, nonprofit medical service

corporations, nonprofit hospital service corporations and health maintenance organizations shall

provide subscribers with an opportunity to select a certified registered nurse practitioner, who is a

participating provider, as a primary care provider.

(e) Notwithstanding any law to the contrary, all insurers, nonprofit medical service

corporations, nonprofit hospital service corporations and health maintenance organizations shall

insure that all participating primary care provider certified registered nurse practitioners are

included on any publicly accessible list of participating providers for the respective organization.

SECTION 4. This act shall take effect on January 1, 2010.

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LC01933/SUB A

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