law15223

Chapter 223

2015 -- H 5046
Enacted 07/10/2015

A N A C T

RELATING TO INSURANCE - HEALTH INSURANCE

Introduced By: Representatives McNamara, Azzinaro, Shekarchi, Corvese, and Malik

Date Introduced: January 08, 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

section 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.

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

section 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.

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: