Chapter 205
2015 -- S 0168
Enacted 07/10/2015

A N   A C T
RELATING TO INSURANCE - HEALTH MAINTENANCE ORGANIZATIONS

Introduced By: Senator James E. Doyle
Date Introduced: February 05, 2015

It is enacted by the General Assembly as follows:
     SECTION 1. Section 27-18-48 of the General Laws in Chapter 27-18 entitled "Accident
and Sickness Insurance Policies" is hereby amended to read as follows:
     27-18-48. Third party reimbursement for services of certain health care workers. --
(a) Every individual or group hospital or medical services plan contract delivered, issued or
renewed by an insurer or nonprofit or for profit for-profit health service corporation which that
provides benefits to individual subscribers and members within the state, or to all group members
having a principal place of employment within the state, shall provide benefits for services
rendered by a certified registered nurse anesthetist designated as a certified registered nurse
anesthetist by the board of nurse registration and nursing education; provided, that the following
conditions are met:
      (1) The certified registered nurse anesthetist provides certain health care services under
the supervision of anesthesiologists, licensed physicians or licensed dentists in accordance with §
5-34.2-2(c), which requires substantial specialized knowledge, judgment and skill related to the
administration of anesthesia, including pre-operative and post-operative assessment of patients;
administering anesthetics; monitoring patients during anesthesia; management of fluids in
intravenous therapy and management of respiratory care; The certified registered nurse
anesthetist adheres to the practice of certified registered nurse anesthesia as defined by, and in
accordance with, § 5-34.2-2.
      (2) The policy or contract currently provides benefits for identical services rendered by a
provider of health care licensed by the state; and
      (3) The certified registered nurse anesthetist is not a salaried employee of the licensed
hospital or facility for which the accident and sickness insurer has an alternative contractual
relationship to fund the services of a certified registered nurse anesthetist.
      (b) It shall remain within the sole discretion of the health maintenance organization as to
which certified registered nurse anesthetists it shall contract with. Reimbursement shall be
provided according to the respective principles and policies of the health maintenance
organization; provided, that no health maintenance organization may be required to pay for
duplicative services actually rendered by a certified registered nurse anesthetist and any other
health care provider. Nothing contained in this section shall preclude the health maintenance
organization from conducting managed care, medical necessity necessity, or utilization review.
     (c) Providers. – A group health plan and a health insurance issuer offering group or
individual health insurance coverage shall not discriminate with respect to participation under the
plan or coverage against any health care provider who is acting within the scope of that provider's
license or certification under applicable state law. This section shall not require that a group
health plan or health insurance issuer contract with any health care provider willing to abide by
the terms and conditions for participation established by the plan or issuer. Nothing in this section
shall be construed as preventing a group health plan or a health insurance issuer from
establishing varying reimbursement rates based on quality or performance measures.
     SECTION 2. Section 27-19-40 of the General Laws in Chapter 27-19 entitled "Nonprofit
Hospital Service Corporations" is hereby amended to read as follows:
     27-19-40. Third party Third-party reimbursement for services of certain health care
workers. -- (a) Every individual or group health insurance contract, plan plan, or policy
delivered, issued issued, or renewed by an insurer or nonprofit or for profit for-profit health
service corporation which that provides benefits to individual subscribers and members within
the state, or to all group members having a principal place of employment within the state, shall
provide benefits for services rendered by a certified registered nurse anesthetist designated as a
certified registered nurse anesthetist by the board of nurse registration and nursing education;
provided, that the following conditions are met:
      (1) The certified registered nurse anesthetist provides certain health care services under
the supervision of anesthesiologists, licensed physicians or licensed dentists in accordance with §
5-34.2-2(c), which requires substantial specialized knowledge, judgment and skill related to the
administration of anesthesia, including pre-operative and post-operative assessment of patients;
administering anesthetics, monitoring patients during anesthesia; management of fluids in
intravenous therapy and management of respiratory care; adheres to the practice of certified
registered nurse anesthesia as defined by and in accordance with § 5-34.2-2.
      (2) The policy or contract currently provides benefits for identical services rendered by a
provider of health care licensed by the state; and
      (3) The certified registered nurse anesthetist is not a salaried employee of the licensed
hospital or facility for which the nonprofit hospital service corporation has an alternative
contractual relationship to fund the services of a certified registered nurse anesthetist.
      (b) It shall remain within the sole discretion of the nonprofit hospital service corporation
as to which certified registered nurse anesthetists it shall contract with. Reimbursement shall be
provided according to the respective principles and policies of the nonprofit hospital service
corporation; provided, that no nonprofit hospital service corporation may be required to pay for
duplicative services actually rendered by a certified registered nurse anesthetist and any other
health care provider. Nothing contained in this section shall preclude the nonprofit hospital
service corporation from conducting managed care, medical necessity necessity, or utilization
review.
     (c) Providers. – A group health plan and a health insurance issuer offering group or
individual health insurance coverage shall not discriminate with respect to participation under the
plan or coverage against any health care provider who is acting within the scope of that provider's
license or certification under applicable state law. This section shall not require that a group
health plan or health insurance issuer contract with any health care provider willing to abide by
the terms and conditions for participation established by the plan or issuer. Nothing in this section
shall be construed as preventing a group health plan or a health insurance issuer from
establishing varying reimbursement rates based on quality or performance measures.
     SECTION 3. Section 27-20-35 of the General Laws in Chapter 27-20 entitled "Nonprofit
Medical Service Corporations" is hereby amended to read as follows:
     27-20-35. Third party reimbursement for services of certain health care workers. --
(a) Every individual or group health insurance contract, plan plan, or policy delivered, issued
issued, or renewed by an insurer or nonprofit or for profit for-profit health service corporation
which that provides benefits to individual subscribers and members within the state, or to all
group members having a principal place of employment within the state, shall provide benefits
for services rendered by a certified registered nurse anesthetist designated as a certified registered
nurse anesthetist by the board of nurse registration and nursing education; provided, that the
following conditions are met:
      (1) The certified registered nurse anesthetist provides certain health care services under
the supervision of anesthesiologists, licensed physicians or licensed dentists in accordance with §
5-34.2-2(c), which requires substantial specialized knowledge, judgment and skill related to the
administration of anesthesia, including pre-operative and post-operative assessment of patients;
administering anesthetics; monitoring patients during anesthesia; management of fluids in
intravenous therapy and management of respiratory care; adheres to the practice of certified
registered nurse anesthesia as defined by and in accordance with § 5-34.2-2.
      (2) The policy or contract currently provides benefits for identical services rendered by a
provider of health care licensed by the state; and
      (3) The certified registered nurse anesthetist is not a salaried employee of the licensed
hospital or facility for which the nonprofit medical service corporation has an alternative
contractual relationship to fund the services of a certified registered nurse anesthetist.
      (b) It shall remain within the sole discretion of the nonprofit medical service corporation
as to which certified registered nurse anesthetists it shall contract with. Reimbursement shall be
provided according to the respective principles and policies of the nonprofit medical service
corporation; provided, that no nonprofit medical service corporation may be required to pay for
duplicative services actually rendered by a certified registered nurse anesthetist and any other
health care provider. Nothing contained in this section shall preclude the nonprofit medical
service corporation from conducting managed care, medical necessity necessity, or utilization
review.
     (c) Providers. – A group health plan and a health insurance issuer offering group or
individual health insurance coverage shall not discriminate with respect to participation under the
plan or coverage against any health care provider who is acting within the scope of that provider's
license or certification under applicable state law. This section shall not require that a group
health plan or health insurance issuer contract with any health care provider willing to abide by
the terms and conditions for participation established by the plan or issuer. Nothing in this section
shall be construed as preventing a group health plan or a health insurance issuer from
establishing varying reimbursement rates based on quality or performance measures.
     SECTION 4. Section 27-41-49 of the General Laws in Chapter 27-41 entitled "Health
Maintenance Organizations" is hereby amended to read as follows:
     27-41-49. Third party reimbursement for services of certain health care workers. --
(a) Every individual or group health insurance contract, plan plan, or policy delivered, issued
issued, or renewed by an insurer, health maintenance organization, nonprofit or for profit for-
profit health service corporation which that provides benefits to individual subscribers and
members within the state, or to all group members having a principal place of employment within
the state, shall provide benefits for services rendered by a certified registered nurse anesthetist
designated as a certified registered nurse anesthetist by the board of nurse registration and nursing
education; provided, that the following conditions are met:
      (1) The certified registered nurse anesthetist provides certain health care services under
the supervision of anesthesiologists, licensed physicians or licensed dentists in accordance with §
5-34.2-2(c), which requires substantial specialized knowledge, judgment and skill related to the
administration of anesthesia, including pre-operative and post-operative assessment of patients;
administering anesthetics; monitoring patients during anesthesia; management of fluids in
intravenous therapy and management of respiratory care; adheres to the practice of certified
registered nurse anesthesia as defined by and in accordance with § 5-34.2-2.
      (2) The policy or contract currently provides benefits for identical services rendered by a
provider of health care licensed by the state; and
      (3) The certified registered nurse anesthetist is not a salaried employee of the licensed
hospital or facility for which the health maintenance organization has an alternative contractual
relationship to fund the services of a certified registered nurse anesthetist.
      (b) It shall remain within the sole discretion of the health maintenance organization as to
which certified registered nurse anesthetists it shall contract with. Reimbursement shall be
provided according to the respective principles and policies of the health maintenance
organization; provided, that no health maintenance organization may be required to pay for
duplicative services actually rendered by a certified registered nurse anesthetist and any other
health care provider. Nothing contained in this section shall preclude the health maintenance
organization from conducting managed care, medical necessity necessity, or utilization review.
     (c) Providers. – A group health plan and a health insurance issuer offering group or
individual health insurance coverage shall not discriminate with respect to participation under the
plan or coverage against any health care provider who is acting within the scope of that provider's
license or certification under applicable state law. This section shall not require that a group
health plan or health insurance issuer contract with any health care provider willing to abide by
the terms and conditions for participation established by the plan or issuer. Nothing in this section
shall be construed as preventing a group health plan or a health insurance issuer from
establishing varying reimbursement rates based on quality or performance measures.
     SECTION 5. This act shall take effect upon passage.
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LC000774
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