2012 -- S 2761

=======

LC01776

=======

STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2012

____________

A N A C T

RELATING TO INSURANCE -- ESTABLISHING MINIMUM PHYSICIAN

REIMBURSEMENT RATES FOR PAYMENTS FROM COMMERCIAL HEALTH INSURERS

     Introduced By: Senator Maryellen Goodwin

     Date Introduced: March 08, 2012

     Referred To: Senate Health & Human Services

It is enacted by the General Assembly as follows:

1-1

     SECTION 1. Title 27 of the General Laws entitled "INSURANCE" is hereby amended

1-2

by adding thereto the following chapter:

1-3

     CHAPTER 69.1

1-4

MINIMUM PHYSICIAN PAYMENTS ACT OF 2012

1-5

     27-69.1-1. Short title. – This chapter shall be known and may be cited as the "Minimum

1-6

Physician Payments Act of 2012" or "MPPA."

1-7

     27-69.1-2. Legislative findings. – The general assembly hereby finds and declares as

1-8

follows:

1-9

     (1) Most Rhode Island physicians are paid substantially less by commercial health

1-10

insurers than are physicians providing the same services in Connecticut and Massachusetts;

1-11

     (2) This payment inequity has made it difficult to recruit and retain physicians in Rhode

1-12

Island;

1-13

     (3) The inability to recruit and retain sufficient numbers of physicians poses a long-term

1-14

threat to Rhode Islanders' ability to access high quality medical care;

1-15

     (4) The federal Medicare program has a well established and generally fair method for

1-16

determining physician reimbursement;

1-17

     (5) Commercial health insurers in Massachusetts and Connecticut generally reimburse

1-18

physicians at greater rates than does Medicare; and

2-19

     (6) This chapter is necessary, proper and constitutes an appropriate exercise of the

2-20

authority of this state to regulate the delivery of health care services in order to safeguard the

2-21

public health and safety of Rhode Islanders.

2-22

     27-69.1-3. Definitions. – The following words and phrases, when used in this chapter,

2-23

shall have the meanings given to them in this section unless the context clearly indicates

2-24

otherwise:

2-25

     (1) "Department" means the Rhode Island department of health.

2-26

     (2) "Eligible physician" means any person licensed as a physician by the department

2-27

pursuant to chapter 5-37, who is a participating provider in Rhode Island medical assistance and

2-28

RIteCare and certifies to the director of the department annually that at least five percent (5%) of

2-29

the care provided by the physician is free care as defined by the department.

2-30

     (3) "Health care insurer" means a health care insurer whose premiums are paid in whole

2-31

or in part by employers and as otherwise defined in section 27-20.6-1, including any health care

2-32

insurer affiliate or third-party administrator interacting with hospitals and enrollees on behalf of

2-33

such an insurer, but specifically not including the following types of insurance policy:

2-34

     (i) Hospital confinement indemnity;

2-35

     (ii) Disability income;

2-36

     (iii) Accident only;

2-37

     (iv) Long-term care;

2-38

     (v) Medicare supplement;

2-39

     (vi) Limited benefit health;

2-40

     (vii) Specified disease indemnity;

2-41

     (viii) Sickness or bodily injury or death by accident or both;

2-42

     (ix) Other limited benefit policies; and

2-43

     (x) Health care insurance issued or administered by a small health care insurer.

2-44

     (4) "Health care insurer affiliate" means a health care insurer that is affiliated with

2-45

another entity by either the insurer or entity having a five percent (5%) or greater, direct or

2-46

indirect, ownership or investment interest in the other through equity, debt or other means.

2-47

     27-69.1-4. Minimum payments. – (a) Health insurers shall reimburse eligible physicians

2-48

no less than one hundred twenty-five percent (125%) of what Medicare would pay the physician

2-49

for providing the same service.

2-50

     (b) Nothing in this chapter shall be construed to prohibit a physician, or the physician's

2-51

lawful employer, from contracting with a health insurer to receive greater reimbursement than

2-52

that required under this chapter.

3-53

     SECTION 2. This act shall take effect on January 1, 2013.

=======

LC01776

========

EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N A C T

RELATING TO INSURANCE -- ESTABLISHING MINIMUM PHYSICIAN

REIMBURSEMENT RATES FOR PAYMENTS FROM COMMERCIAL HEALTH INSURERS

***

4-1

     This act would require commercial health insurers to pay physicians at least one hundred

4-2

twenty-five percent (125%) of Medicare rates, if those physicians participate in medical

4-3

assistance and RIteCare, and provide at least five percent (5%) free care.

4-4

     This act would take effect on January 1, 2013.

=======

LC01776

=======