§ 27-19-43. Restricted annual rate payments prohibited.
(a) No corporation organized under this chapter shall compensate any provider of outpatient service by using the restricted annual rate method of payment.
(b) The “restricted annual rate method of payment” is defined as any method of payment that sets, as all or part of its payment scheme, a total payment limit for mental health and/or substance abuse treatment services for each person seeking treatment based on a per person per unit of time criterion that disregards the extent of treatment and/or degree of services rendered.
(c) This prohibition shall not be construed to prohibit or limit capitation or other risk sharing agreements between providers and insurers otherwise permissible by law.
History of Section.P.L. 1998, ch. 352, § 2.
Structure Rhode Island General Laws
Chapter 27-19 - Nonprofit Hospital Service Corporations
Section 27-19-1. - Definitions.
Section 27-19-2. - Organization as charitable corporation — Insurance laws inapplicable.
Section 27-19-2.1. - Investments and holdings in certain corporations authorized.
Section 27-19-4. - Certificate of public convenience and advantage.
Section 27-19-5. - Contracts with subscribers, hospitals, and other eligible entities.
Section 27-19-5.1. - Cancellation of coverage by employers.
Section 27-19-5.2. - Patient responsibility — Administrative requirements.
Section 27-19-5.3. - Additional powers.
Section 27-19-6. - Rates charged subscribers — Reserves. [Effective until January 1, 2023.]
Section 27-19-7. - Rates charged by hospitals.
Section 27-19-7.1. - Uniform explanation of benefits and coverage.
Section 27-19-7.2. - Filing of policy forms.
Section 27-19-8. - Annual and quarterly statements.
Section 27-19-9. - Examination of affairs of corporations.
Section 27-19-10. - Commission plans for solicitors or insurance producers.
Section 27-19-11. - Investment standards.
Section 27-19-12. - Corporations deemed public charitable institutions.
Section 27-19-13. - Services rendered in certain institutions.
Section 27-19-17. - Additional benefits.
Section 27-19-18. - Coverage for adoptive children.
Section 27-19-19. - Changing coverage.
Section 27-19-20. - Mammograms and pap smears — Coverage mandated.
Section 27-19-21. - Mammograms — Quality assurance standards.
Section 27-19-22. - Pap smears — Quality assurance standards.
Section 27-19-23. - Coverage for infertility.
Section 27-19-23.1. - Insurance coverage for post-partum hospital stays.
Section 27-19-24. - Nonprofit hospital service corporations assessment.
Section 27-19-25. - Discontinuance of coverage — Chronic disabilities.
Section 27-19-26. - Drug coverage.
Section 27-19-26.1. - Medication synchronization.
Section 27-19-28. - Rehabilitation, liquidation, or conservation.
Section 27-19-29. - Holding company systems.
Section 27-19-29.1. - No derogation of attorney general.
Section 27-19-30. - Regulations.
Section 27-19-30.1. - Health insurance rates.
Section 27-19-32.1. - Repealed.
Section 27-19-32.2. - Repealed.
Section 27-19-32.3. - Repealed.
Section 27-19-34. - Mastectomy treatment.
Section 27-19-34.1. - Insurance coverage for mastectomy hospital stays.
Section 27-19-35. - Diabetes treatment.
Section 27-19-36. - Primary and preventive obstetric and gynecological care.
Section 27-19-36.1. - Hysterectomy or myomectomy treatment.
Section 27-19-37. - Whistleblowers protection.
Section 27-19-38. - Penalties and remedies.
Section 27-19-39. - Additional relief and damages — Reinstatement.
Section 27-19-40. - Third-party reimbursement for services of certain healthcare workers.
Section 27-19-40.1. - Third party reimbursement for services of registered nurse first assistants.
Section 27-19-41. - Human leukocyte antigen testing.
Section 27-19-42. - Drug coverage.
Section 27-19-43. - Restricted annual rate payments prohibited.
Section 27-19-44. - Genetic testing.
Section 27-19-44.1. - Genetic information.
Section 27-19-46. - Magnetic resonance imaging — Quality assurance standards.
Section 27-19-47. - Acupuncture services.
Section 27-19-48. - F.D.A. approved prescription contraceptive drugs and devices.
Section 27-19-50. - Eligibility for children’s benefits.
Section 27-19-51. - Hearing aids.
Section 27-19-52. - Prompt processing of claims.
Section 27-19-53. - Mandatory coverage for certain lyme disease treatments.
Section 27-19-54. - Dental insurance assignment of benefits.
Section 27-19-55. - Coverage for early intervention services.
Section 27-19-56. - Post-payment audits.
Section 27-19-57. - Tobacco cessation programs.
Section 27-19-58. - Reimbursement for orthotics and prosthetic services.
Section 27-19-59. - Mandatory coverage for scalp hair prosthesis.
Section 27-19-60. - Licensed ambulance service.
Section 27-19-61. - Enteral nutrition products.
Section 27-19-62. - Prohibition on rescission of coverage.
Section 27-19-63. - Prohibition on annual and lifetime limits.
Section 27-19-64. - Coverage for individuals participating in approved clinical trials.
Section 27-19-65. - Medical loss ratio reporting and rebates.
Section 27-19-66. - Emergency services.
Section 27-19-67. - Internal and external appeal of adverse benefit determinations.
Section 27-19-68. - Prohibition on preexisting condition exclusions.
Section 27-19-69. - Primary care provider designation requirement.
Section 27-19-70. - Discretionary clauses.
Section 27-19-71. - Orally administered anticancer medication — Cost-sharing requirement.
Section 27-19-72. - Consumer notification.
Section 27-19-73. - Opioid antagonists.
Section 27-19-74. - Healthcare provider credentialing.
Section 27-19-75. - Unfair discrimination prohibited.
Section 27-19-76. - Health insurance contracts — Full year coverage for contraception.
Section 27-19-77. - Prohibition on discrimination in organ transplants.
Section 27-19-78. - Health insurance contracts — Copayments exemption for COVID-19 vaccinations.
Section 27-19-79. - Perinatal doulas.
Section 27-19-80. - Gender rating. [Effective January 1, 2023.]