§ 27-41-49. Third-party reimbursement for services of certain healthcare workers.
(a) Every individual or group health insurance contract, plan, or policy delivered, issued, or renewed by an insurer, health maintenance organization, nonprofit or for-profit health service corporation that provides benefits to individual subscribers and members within the state, or to all group members having a principal place of employment within the state, shall provide benefits for services rendered by a certified registered nurse anesthetist designated as a certified registered nurse anesthetist by the board of nurse registration and nursing education; provided, that the following conditions are met:
(1) The certified registered nurse anesthetist adheres to the practice of certified registered nurse anesthesia as defined by and in accordance with § 5-34.2-2.
(2) The policy or contract currently provides benefits for identical services rendered by a provider of health care licensed by the state; and
(3) The certified registered nurse anesthetist is not a salaried employee of the licensed hospital or facility for which the health maintenance organization has an alternative contractual relationship to fund the services of a certified registered nurse anesthetist.
(b) It shall remain within the sole discretion of the health maintenance organization as to which certified registered nurse anesthetists it shall contract with. Reimbursement shall be provided according to the respective principles and policies of the health maintenance organization; provided, that no health maintenance organization may be required to pay for duplicative services actually rendered by a certified registered nurse anesthetist and any other healthcare provider. Nothing contained in this section shall preclude the health maintenance organization from conducting managed care, medical necessity, or utilization review.
(c) Providers. A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any healthcare provider who is acting within the scope of that provider’s license or certification under applicable state law. This section shall not require that a group health plan or health insurance issuer contract with any healthcare provider willing to abide by the terms and conditions for participation established by the plan or issuer. Nothing in this section shall be construed as preventing a group health plan or a health insurance issuer from establishing varying reimbursement rates based on quality or performance measures.
History of Section.P.L. 1997, ch. 345, § 4; P.L. 1997, ch. 365, § 4; P.L. 2002, ch. 292, § 85; P.L. 2015, ch. 205, § 4; P.L. 2015, ch. 223, § 4.
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.]