2001 -- H 5776
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LC01487
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S T A T E O F R H O D E I S L A N D
IN GENERAL ASSEMBLY
JANUARY SESSION, A.D. 2001
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A N A C T
RELATING TO INSURANCE -- PARTICIPATING PROVIDER AGREEMENTS
It is enacted by the General Assembly as follows:
SECTION 1. Chapter 27-18 of the General Laws entitled "Accident and Sickness Insurance Policies" is hereby amended by adding thereto the following section:
27-18-61. Participating provider agreements. -- (a) It shall be unlawful for a health care entity to require a health care provider, as a condition of participating in any one (1) of its health plans, to participate currently or prospectively in the health care entity's other health plans.
(b) Any provision of a contract between a health care entity and a health care provider that requires a health care provider, as a condition of participating in any one (1) of the health care entity's health plans, to participate currently or prospectively in the health care entity's other health plans, shall be void and of no force and effect.
(c) For purposes of this section, the following definitions shall apply:
(1) "Health care entity" means a limited insurance company, insurer, hospital or medical service corporation or hospital or dental or medical service plan or health maintenance organization, or a contractor as described in section 23-17.13-2(B), that operates a health plan.
(2) "Health care provider" means a physician, hospital, pharmacy, laboratory, dentist or other state licensed or state recognized provider of health care services or supplies that has entered into an agreement with a health care entity to provide such services or supplies to a patient enrolled in a health plan.
(3) "Health care services" include, but are not limited to, medical, mental health, substance abuse, dental and any other services covered under the terms of the specific health plan.
(4) "Health plan" means a plan operated by a health care entity that provides for the delivery of health care services to persons enrolled in such plans. The term "health plan" shall not include a health plan operated pursuant to a contract with the state or federal government for the benefit of individuals eligible for provider services under title XIX of the social security act or under chapter 40-8 of the Rhode Island general laws.
SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service Corporations" is hereby amended by adding thereto the following section:
27-19-52. Participating provider agreements. -- (a) It shall be unlawful for a health care entity to require a health care provider, as a condition of participating in any one (1) of its health plans, to participate currently or prospectively in the health care entity's other health plans.
(b) Any provision of a contract between a health care entity and a health care provider that requires a health care provider, as a condition of participating in any one (1) of the health care entity's health plans, to participate currently or prospectively in the health care entity's other health plans, shall be void and of no force and effect.
(c) For purposes of this section, the following definitions shall apply:
(1) "Health care entity" means a limited insurance company, insurer, hospital or medical service corporation or hospital or dental or medical service plan or health maintenance organization, or a contractor as described in section 23-17.13-2(B), that operates a health plan.
(2) "Health care provider" means a physician, hospital, pharmacy, laboratory, dentist or other state licensed or state recognized provider of health care services or supplies that has entered into an agreement with a health care entity to provide such service or supplies to a patient enrolled in a health plan.
(3) "Health care services" include, but are not limited to, medical, mental health, substance abuse, dental and any other services covered under the terms of the specific health plan; and
(4) "Health plan" means a plan operated by a health care entity that provides for the delivery of health care services to persons enrolled in such plans. The term "health plan" shall not include a health plan operated pursuant to a contract with the state or federal government for the benefit of individuals eligible for provider services under title XIX of the social security act or under chapter 40-8 of the Rhode Island general laws.
SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service Corporations" is hereby amended by adding thereto the following section:
27-20-47. Participating provider agreements. -- (a) It shall be unlawful for a health care entity to require a health care provider, as a condition of participating in any one (1) of its health plans, to participate currently or prospectively in the health care entity's other health plans.
(b) Any provision of a contract between a health care entity and a health care provider that requires a health care provider, as a condition of participating in any one (1) of the health care entity's health plans, to participate currently or prospectively in the health care entity's other health plans, shall be void and of no force and effect.
(c) For purposes of this section, the following definitions shall apply:
(1) "Health care entity" means a limited insurance company, insurer, hospital or medical service corporation or hospital or dental or medical service plan or health maintenance organization, or a contractor as described in section 23-17.13-2(B), that operates a health plan.
(2) "Health care provider" means a physician, hospital, pharmacy, laboratory, dentist or other state licensed or state recognized provider of health care services or supplies that has entered into an agreement with a health care entity to provide such services or supplies to a patient enrolled in a health plan.
(3) "Health care services" include, but are not limited to, medical, mental health, substance abuse, dental and any other services covered under the terms of the specific health plan.
(4) "Health plan" means a plan operated by a health care entity that provides for the delivery of health care services to persons enrolled in such plans. The term "health plan" shall not include a health plan operated pursuant to a contract with the state or federal government for the benefit of individuals eligible for provider services under title XIX of the social security act or under chapter 40-8 of the Rhode Island general laws.
SECTION 4. Chapter 27-20.1 of the General Laws entitled "Nonprofit Dental Service Corporations" is hereby amended by adding thereto the following section:
27-20.1-18. Participating provider agreements. -- (a) It shall be unlawful for a health care entity to require a health care provider, as a condition of participating in any one (1) of its health plans, to participate currently or prospectively in the health care entity's other health plans.
(b) Any provision of a contract between a health care entity and a health care provider that requires a health care provider, as a condition of participating in any one (1) of the health care entity's health plans, to participate currently or prospectively in the health care entity's other health plans, shall be void and of no force and effect.
(c) For purposes of this section, the following definitions shall apply:
(1) "Health care entity" means a limited insurance company, insurer, hospital or medical service corporation or hospital or dental or medical service plan or health maintenance organization, or a contractor as described in section 23-17.13-2(B), that operates a health plan.
(2) "Health care provider" means a physician, hospital, pharmacy, laboratory, dentist or other state licensed or state recognized provider of health care services or supplies that has entered into an agreement with a health care entity to provide such services or supplies to a patient enrolled in a health plan.
(3) "Health care services" include, but are not limited to, medical, mental health, substance abuse, dental and any other services covered under the terms of the specific health plan.
(4) "Health plan" means a plan operated by a health care entity that provides for the delivery of health care services to persons enrolled in such plans. The term "health plan" shall not include a health plan operated pursuant to a contract with the state or federal government for the benefit of individuals eligible for provider services under title XIX of the social security act or under chapter 40-8 of the Rhode Island general laws.
SECTION 5. Chapter 27-41 of the General Laws entitled "Health Maintenance Organizations" is hereby amended by adding thereto the following section:
27-41-64. Participating provider agreements. -- (a) It shall be unlawful for a health care entity to require a health care provider, as a condition of participating in any one (1) of its health plans, to participate currently or prospectively in the health care entity's other health plans.
(b) Any provision of a contract between a health care entity and a health care provider that requires a health care provider, as a condition of participating in any one (1) of the health care entity's health plans, to participate currently or prospectively in the health care entity's other health plans, shall be void and of no force and effect.
(c) For purposes of this section, the following definitions shall apply:
(1) "Health care entity" means a limited insurance company, insurer, hospital or medical service corporation or hospital or dental or medical service plan or health maintenance organization or a contractor as described in section 23-17.13-2(B), that operates a health plan.
(2) "Health care provider" means a physician, hospital, pharmacy, laboratory, dentist or other state licensed or state recognized provider of health care services or supplies that has entered into an agreement with a health care entity to provide such services or supplies to a patient enrolled in a health plan.
(3) "Health care services" include, but are not limited to, medical, mental health, substance abuse, dental and any other services covered under the terms of the specific health plan.
(4) "Health plan" means a plan operated by a health care entity that provides for the delivery of health care services to persons enrolled in such plans. The term "health plan" shall not include a health plan operated pursuant to a contract with the state or federal government for the benefit of individuals eligible for provider services under title XIX of the social security act or under chapter 40-8 of the Rhode Island general laws.
SECTION 6. This act shall take effect upon passage.
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LC01487
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EXPLANATION
BY THE LEGISLATIVE COUNCIL
OF
A N A C T
RELATING TO INSURANCE -- PARTICIPATING PROVIDER AGREEMENTS
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This act would make it unlawful for a health care entity to require a health care provider, as a condition of participating in any one (1) of its health plans, to participate currently or prospectively in the health care entity's other health plans.
This act would take effect upon passage.