§ 27-20-27.2. Conditions of coverage. [Repealed on effective date of § 27-20-64.]
As provided in § 27-20-27, coverage shall be extended to new cancer therapies still under investigation when the following circumstances are present:
(1) Treatment is being provided pursuant to a phase II, III or IV clinical trial which has been approved by the National Institutes of Health (NIH) in cooperation with the National Cancer Institute (NCI), community clinical oncology programs; the Food and Drug Administration in the form of an investigational new drug (IND) exemption; the Department of Veterans’ Affairs; or a qualified nongovernmental research entity as identified in the guidelines for NCI cancer center support grants;
(2) The proposed therapy has been reviewed and approved by a qualified institutional review board (IRB);
(3) The facility and personnel providing the treatment are capable of doing so by virtue of their experience, training, and volume of patients treated to maintain expertise;
(4) The patients receiving the investigational treatment meet all protocol requirements;
(5) There is no clearly superior, noninvestigational alternative to the protocol treatment;
(6) The available clinical or preclinical data provide a reasonable expectation that the protocol treatment will be at least as efficacious as the noninvestigational alternative; and
(7) The coverage of new cancer therapy treatment provided pursuant to a phase II clinical trial is not required for only that portion of that treatment that is provided as part of the phase II clinical trial and is funded by a national agency, such as the National Cancer Institute, the Veteran’s Administration, the Department of Defense, or funded by commercial organizations such as the biotechnical and/or pharmaceutical industry or manufacturers of medical devices. Any portions of a phase II trial which are customarily funded by government, biotechnical and/or pharmaceutical and/or medical device industry sources in Rhode Island or in other states shall continue to be funded in Rhode Island and coverage pursuant to this section supplements, does not supplant customary funding.
History of Section.P.L. 1994, ch. 301, § 3; P.L. 1997, ch. 51, §§ 3, 7; P.L. 1997, ch. 92, §§ 3, 7; P.L. 1999, ch. 134, § 3.
Structure Rhode Island General Laws
Chapter 27-20 - Nonprofit Medical Service Corporations
Section 27-20-1. - Definitions.
Section 27-20-1.1. - Applicability.
Section 27-20-2. - Organization as charitable corporation — Insurance laws inapplicable.
Section 27-20-3. - Qualifications of directors.
Section 27-20-4. - Approval of articles of association.
Section 27-20-5. - Contracts with subscribers.
Section 27-20-5.1. - Cancellation of coverage by employers.
Section 27-20-5.2. - Repealed.
Section 27-20-5.3. - Patient responsibility — Administrative requirements.
Section 27-20-6.1. - Uniform explanation of benefits and coverage.
Section 27-20-6.2. - Filing of policy forms.
Section 27-20-7. - Relationship of physician and patient — Actions against corporation.
Section 27-20-8. - Annual and quarterly statements.
Section 27-20-9. - Examination of affairs of corporation.
Section 27-20-10. - Commission plans for solicitors or insurance producers.
Section 27-20-11. - Investment standards.
Section 27-20-12. - Corporation deemed public charitable institution.
Section 27-20-13. - Adoption of chapter by hospital service corporation.
Section 27-20-14. - Coverage for adoptive children.
Section 27-20-15. - Itemized bills for services rendered.
Section 27-20-16. - Changing coverage.
Section 27-20-17. - Mammograms and pap smears — Coverage mandated.
Section 27-20-17.1. - Insurance coverage for post-partum hospital stays.
Section 27-20-18. - Mammograms — Quality assurance standards.
Section 27-20-19. - Pap smears — Quality assurance standards.
Section 27-20-20. - Coverage for infertility.
Section 27-20-21. - Nonprofit medical service corporation assessment.
Section 27-20-22. - Discontinuance of coverage — Chronic disabilities.
Section 27-20-23. - Drug coverage.
Section 27-20-23.1. - Medication synchronization.
Section 27-20-24. - Rehabilitation, liquidation, or conservation.
Section 27-20-25. - Holding company systems.
Section 27-20-25.1. - No derogation of attorney general.
Section 27-20-25.2. - Health insurance rates.
Section 27-20-26. - Regulations.
Section 27-20-27.1. - “Reliable evidence” defined. [Repealed on effective date of § 27-20-64.]
Section 27-20-27.2. - Conditions of coverage. [Repealed on effective date of § 27-20-64.]
Section 27-20-27.3. - Managed care. [Repealed on effective date of § 27-20-64.]
Section 27-20-29. - Mastectomy treatment.
Section 27-20-29.1. - Insurance coverage for mastectomy hospital stays.
Section 27-20-30. - Diabetes treatment.
Section 27-20-31. - Primary and preventive obstetric and gynecological care.
Section 27-20-31.1. - Hysterectomy or myomectomy treatment.
Section 27-20-32. - Whistleblowers protection.
Section 27-20-33. - Penalties and remedies.
Section 27-20-34. - Additional relief and damages — Reinstatement.
Section 27-20-35. - Third-party reimbursement for services of certain healthcare workers.
Section 27-20-35.1. - Third party reimbursement for services of registered nurse first assistants.
Section 27-20-36. - Human leukocyte antigen testing.
Section 27-20-37. - Drug coverage.
Section 27-20-38. - Restricted annual rate payments prohibited.
Section 27-20-39. - Genetic testing.
Section 27-20-39.1. - Genetic information.
Section 27-20-41. - Magnetic resonance imaging — Quality assurance standards.
Section 27-20-42. - Acupuncture services.
Section 27-20-43. - F.D.A. approved prescription contraceptive drugs and devices.
Section 27-20-45. - Eligibility for children’s benefits.
Section 27-20-46. - Hearing aids.
Section 27-20-47. - Prompt processing of claims.
Section 27-20-48. - Mandatory coverage for certain lyme disease treatments.
Section 27-20-49. - Dental insurance assignment of benefits.
Section 27-20-50. - Coverage for early intervention services.
Section 27-20-51. - Post-payment audits.
Section 27-20-52. - Reimbursement for orthotics and prosthetic services.
Section 27-20-53. - Tobacco cessation programs.
Section 27-20-54. - Mandatory coverage for scalp hair prosthesis.
Section 27-20-55. - Licensed ambulance service.
Section 27-20-56. - Enteral nutrition products.
Section 27-20-57. - Prohibition on preexisting condition exclusions.
Section 27-20-58. - Prohibition on rescission of coverage.
Section 27-20-59. - Annual and lifetime limits.
Section 27-20-60. - Coverage for individuals participating in approved clinical trials.
Section 27-20-61. - Medical loss ratio reporting and rebates.
Section 27-20-62. - Emergency services.
Section 27-20-63. - Internal and external appeal of adverse benefit determinations.
Section 27-20-65. - Primary care provider designation requirement.
Section 27-20-66. - Discretionary clauses.
Section 27-20-67. - Orally administered anticancer medication — Cost-sharing requirement.
Section 27-20-68. - Consumer notification.
Section 27-20-69. - Opioid antagonists.
Section 27-20-70. - Healthcare provider credentialing.
Section 27-20-71. - Unfair discrimination prohibited.
Section 27-20-72. - Health insurance contracts — Full year coverage for contraception.
Section 27-20-73. - Prohibition on discrimination in organ transplants.
Section 27-20-74. - Health insurance contracts — Copayments exemption for COVID-19 vaccinations.
Section 27-20-75. - Perinatal doulas.
Section 27-20-76. - Gender rating. [Effective January 1, 2023.]