§ 27-41-39. Certified registered nurse practitioners and psychiatric and mental health nurse clinical specialists.
(a) Every individual or group policy or contract delivered, issued for delivery, or renewed by a health maintenance organization in this state shall provide coverage for the services of certified registered nurse practitioners, practicing collaboratively and psychiatric and mental health nurse clinical specialists to subscribers, if those services are within the certified registered nurse practitioner’s or psychiatric and mental health nurse clinical specialist’s area of professional competence as established by education and certification, and are currently reimbursed when rendered by any other healthcare provider. No health maintenance organization may be required to pay for duplicative services actually rendered by a certified nurse practitioner and any other healthcare provider.
(b) Nothing in this chapter shall preclude the conducting of managed care reviews and medical necessity reviews by an insurer or hospital or medical service corporation or health maintenance organization.
(c) Every individual or group policy or contract delivered, issued for delivery, or renewed by a health maintenance organization in this state shall provide coverage for certified registered nurse practitioners to provide primary care, intermediate, home, long-term and inpatient care as primary care providers, when said certified registered nurse practitioner is a participating provider, consistent with, and practicing within, the scope of his/her professional license.
(d) Notwithstanding any law to the contrary, all insurers, nonprofit medical service corporations, nonprofit hospital service corporations and health maintenance organizations shall provide subscribers with an opportunity to select a certified registered nurse practitioner, who is a participating provider, as a primary care provider.
(e) Notwithstanding any law to the contrary, all insurers, nonprofit medical service corporations, nonprofit hospital service corporations and health maintenance organizations shall insure that all participating primary care provider certified registered nurse practitioners are included on any publicly accessible list of participating providers for the respective organization.
History of Section.P.L. 1991, ch. 361, § 4; P.L. 1994, ch. 90, § 3; P.L. 2002, ch. 292, § 85; P.L. 2009, ch. 351, § 3; P.L. 2009, ch. 352, § 3.
Structure Rhode Island General Laws
Chapter 27-41 - Health Maintenance Organizations
Section 27-41-1. - Short title.
Section 27-41-2. - Definitions.
Section 27-41-3. - Establishment of health maintenance organizations.
Section 27-41-4. - Issuance of license.
Section 27-41-5. - Powers of health maintenance organizations.
Section 27-41-6. - Governing body.
Section 27-41-7. - Fiduciary responsibilities.
Section 27-41-8. - Evidence of coverage and charges for health care services.
Section 27-41-9. - Required reports.
Section 27-41-10. - Information to enrollees.
Section 27-41-11. - Complaint system.
Section 27-41-12. - Investments.
Section 27-41-13. - Protection against insolvency.
Section 27-41-13.1. - Initial net worth and capital requirements.
Section 27-41-13.2. - Ongoing net worth and capital requirements.
Section 27-41-13.3. - Waiver, surplus notes, and risk based capital requirements.
Section 27-41-14. - Prohibited practices.
Section 27-41-14.1. - Prohibition against restraint on provider — Patient communications.
Section 27-41-15. - Powers of insurers and hospital and medical service corporations.
Section 27-41-16. - Examination.
Section 27-41-17. - Suspension or revocation of license.
Section 27-41-18. - Rehabilitation, liquidation, or conservation of health maintenance organization.
Section 27-41-18.1. - Summary orders and supervision.
Section 27-41-19. - Rules and regulations.
Section 27-41-20. - Administrative procedures.
Section 27-41-21. - Penalties and enforcement.
Section 27-41-22. - Statutory construction and relationship to other laws.
Section 27-41-23. - Filings and reports as public documents.
Section 27-41-24. - Director of health’s authority to contract.
Section 27-41-25. - Holding company systems.
Section 27-41-26. - Enrollee liability.
Section 27-41-26.1. - Patient responsibility — Administrative requirements.
Section 27-41-27. - Offer of health maintenance organization alternative to employees.
Section 27-41-27.1. - No derogation of attorney general.
Section 27-41-27.2. - Health insurance rates.
Section 27-41-28. - Applicability.
Section 27-41-29. - Severability.
Section 27-41-29.1. - Uniform explanation of benefits and coverage.
Section 27-41-29.2. - Filing of policy forms.
Section 27-41-30. - Mammograms and pap smears — Coverage mandated.
Section 27-41-30.1. - Post-partum hospital stays.
Section 27-41-31. - Mammograms — Quality assurance standards.
Section 27-41-32. - Pap smears — Quality assurance standards.
Section 27-41-33. - Coverage for infertility.
Section 27-41-34. - Health maintenance organizations’ assessment.
Section 27-41-35. - Enrollment period in the event of insolvency.
Section 27-41-36. - Services of midwives.
Section 27-41-37. - Discontinuance of coverage — Chronic disabilities.
Section 27-41-38. - Drug coverage.
Section 27-41-38.1. - Medication synchronization.
Section 27-41-41.1. - Repealed.
Section 27-41-41.2. - Repealed.
Section 27-41-41.3. - Repealed.
Section 27-41-43. - Mastectomy treatment.
Section 27-41-43.1. - Insurance coverage for mastectomy hospital stays.
Section 27-41-44. - Diabetes treatment.
Section 27-41-45. - Primary and preventive obstetric and gynecological care.
Section 27-41-45.1. - Hysterectomy or myomectomy treatment.
Section 27-41-46. - Whistleblowers protection.
Section 27-41-47. - Penalties and remedies.
Section 27-41-48. - Additional relief and damages — Reinstatement.
Section 27-41-49. - Third-party reimbursement for services of certain healthcare workers.
Section 27-41-49.1. - Third party reimbursement for services of registered nurse first assistants.
Section 27-41-50. - Human leukocyte antigen testing.
Section 27-41-51. - Drug coverage.
Section 27-41-52. - Restricted annual rate payments prohibited.
Section 27-41-53. - Genetic testing.
Section 27-41-53.1. - Genetic information.
Section 27-41-54. - Disassociation prohibited.
Section 27-41-56. - Magnetic resonance imaging — Quality assurance standards.
Section 27-41-57. - Acupuncture services.
Section 27-41-58. - Prohibition against requiring indemnification from dentists.
Section 27-41-59. - F.D.A. approved prescription contraceptive drugs and devices.
Section 27-41-61. - Eligibility for children’s benefits.
Section 27-41-62. - Temporary credentials.
Section 27-41-63. - Hearing aids.
Section 27-41-64. - Prompt processing of claims.
Section 27-41-65. - Mandatory coverage for certain lyme disease treatments.
Section 27-41-66. - Dental insurance assignment of benefits.
Section 27-41-67. - Determination of maximum coverage limitation for prescription drug benefits.
Section 27-41-68. - Coverage for early intervention services.
Section 27-41-69. - Post-payment audits.
Section 27-41-70. - Tobacco cessation programs.
Section 27-41-71. - Mandatory coverage for scalp hair prosthesis.
Section 27-41-72. - Reimbursement for orthotic and prosthetic services.
Section 27-41-73. - Licensed ambulance service.
Section 27-41-74. - Enteral nutrition products.
Section 27-41-75. - Prohibition on rescission of coverage.
Section 27-41-76. - Prohibition on annual and lifetime limits.
Section 27-41-77. - Coverage for individual participating in approved clinical trials.
Section 27-41-78. - Medical loss ratio reporting and rebates.
Section 27-41-79. - Emergency services.
Section 27-41-80. - Internal and external appeal of adverse benefit determinations.
Section 27-41-81. - Prohibition on preexisting condition exclusions.
Section 27-41-82. - Primary care provider designation requirement.
Section 27-41-83. - Discretionary clauses.
Section 27-41-84. - Orally administered anticancer medication — Cost-sharing requirement.
Section 27-41-85. - Consumer notification.
Section 27-41-86. - Opioid antagonists.
Section 27-41-87. - Healthcare provider credentialing.
Section 27-41-88. - Unfair discrimination prohibited.
Section 27-41-89. - Health insurance contracts — Full year coverage for contraception.
Section 27-41-90. - Prohibition on discrimination in organ transplants.
Section 27-41-91. - Health insurance contracts — Copayments exemption for COVID-19 vaccinations.
Section 27-41-92. - Perinatal doulas.
Section 27-41-93. - Gender rating. [Effective January 1, 2023.]