| 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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