2021 -- H 5191

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LC000785

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2021

____________

A N   A C T

RELATING TO BUSINESSES AND PROFESSIONS -- BOARD OF MEDICAL LICENSURE

AND DISCIPLINE

     Introduced By: Representatives Serpa, Bennett, Phillips, and S Lima

     Date Introduced: January 27, 2021

     Referred To: House Health, Education & Welfare

     It is enacted by the General Assembly as follows:

     SECTION 1. Chapter 5-37 of the General Laws entitled "Board of Medical Licensure and

Discipline" is hereby amended by adding thereto the following section:

     5-37-2.2. Prohibition of board certification requirement to practice medicine.

Notwithstanding any provision of this chapter to the contrary, the board shall not

require a physician applicant or physician licensee under its jurisdiction to obtain or maintain a

national or regional board certification that is not otherwise specifically required in this chapter

before it issues a license or license renewal to that physician applicant or physician licensee under

this chapter.

     SECTION 2. Section 27-20.6-1 of the General Laws in Chapter 27-20.6 entitled "Health

Care Insurers - Coordination of Benefits" is hereby amended to read as follows:

     27-20.6-1. Definitions.

     As used in this chapter, the following terms shall have the following meanings:

     (1) "Continued board certification" means an ongoing recertification program through

which physicians are recertified by one or more of the national or regional medical boards, which

includes, but is not limited to, one or more of the medical specialty boards of the American Board

of Medical Specialties, the American Osteopathic Association, the National Board of Physicians

and Surgeons, or any other nationally or regionally-recognized entity providing medical specialty

certification. Continued board certification is separate from and in addition to any recertification

and continuing medical education requirements required pursuant to § 5-37-2.1;

     (2) "Hospital" means a person or governmental entity licensed in accordance with chapter

17 of title 23 to establish, maintain, and operate a hospital.

     (1)(3) "Insurer" means every nonprofit medical service corporation, hospital service

corporation, health maintenance organization, or other insurer offering and/or insuring health

services; the term shall in addition include any entity defined as an insurer under § 42-62-4; and

     (4) "Physician" means a person with a license to practice allopathic or osteopathic medicine

in this state under the provisions of chapter 37 of title 5; and

     (2)(5) "Primary insurer" means the insurer primarily liable in accordance with the anti-

duplication provisions established by regulations promulgated by the director of business

regulation.

     SECTION 3. Chapter 27-20.6 of the General Laws entitled "Health Care Insurers -

Coordination of Benefits" is hereby amended by adding thereto the following section:

     27-20.6-3.1. Continued board certification not to be considered in coordination of

benefits.

     (a) An insurer shall not:

     (1) Deny reimbursement to a physician or hospital for services rendered because the

physician or any physicians within the hospital have not completed continued board certification.

     (2) Provide lower reimbursement for services rendered by a physician or hospital because

the physician or any physicians within the hospital have not completed continued board

certification.

     (3) Prohibit a physician or hospital from participating in any of the insurer's provider

networks because the physician or any physicians within the hospital have not completed

continued board certification.

     (4) Determine a contractual relationship with, or credentialing of, a physician or hospital

based upon the physician or any physician within the hospital's completion or lack of completion

of continued board certification.

     (5) Deny reimbursement to a physician or hospital for services rendered based upon which

continued board certification program or programs the physician or any physicians within the

hospital have completed.

     (6) Provide lower reimbursement to a physician or hospital for services rendered based

upon which continued board certification program or programs the physician or any

physicians within the hospital have completed.

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     SECTION 4. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO BUSINESSES AND PROFESSIONS -- BOARD OF MEDICAL LICENSURE

AND DISCIPLINE

***

     This act would prohibit the board of medical licensure and discipline from requiring

specialty board certification as a condition of licensure. This act also provides that a health care

insurer shall not deny reimbursement or provide lower reimbursement rates to a physician or

hospital, based on a physician's decision whether or not to participate in a national continued board

certification program.

     This act would take effect upon passage.

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