S 0168 S T A T E O F R H O D E I S L A N D
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1 LC S 01 S T A T E O F R H O D E I S L A N D IN GENERAL ASSEMBLY JANUARY SESSION, A.D. 01 A N A C T RELATING TO INSURANCE - HEALTH MAINTENANCE ORGANIZATIONS Introduced By: Senator James E. Doyle Date Introduced: February 0, 01 Referred To: Senate Health & Human Services It is enacted by the General Assembly as follows: SECTION 1. Section -1- of the General Laws in Chapter -1 entitled "Accident and Sickness Insurance Policies" is hereby amended to read as follows: -1-. Third party reimbursement for services of certain health care workers. -- (a) Every individual or group hospital or medical services plan contract delivered, issued or renewed by an insurer or nonprofit or for profit health service corporation which 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: -.-(c), which requires substantial specialized knowledge, judgment and skill related to the administering anesthetics; monitoring patients during anesthesia; management of fluids in intravenous therapy and management of respiratory care; The certified registered nurse anesthetist adheres to the practice of certified registered nurse anesthesia as defined by and in accordance with -.-. () The policy or contract currently provides benefits for identical services rendered by a
2 () The certified registered nurse anesthetist is not a salaried employee of the licensed hospital or facility for which the accident and sickness insurer 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 health care provider. Nothing contained in this section shall preclude the health maintenance organization from conducting managed care, medical necessity or utilization review. SECTION. Section -1-0 of the General Laws in Chapter -1 entitled "Nonprofit Hospital Service Corporations" is hereby amended to read as follows: Third party reimbursement for services of certain health care workers. -- (a) Every individual or group health insurance contract, plan or policy delivered, issued or renewed by an insurer or nonprofit or for profit health service corporation which 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: -.-(c), which requires substantial specialized knowledge, judgment and skill related to the administering anesthetics, monitoring patients during anesthesia; management of fluids in intravenous therapy and management of respiratory care; adheres to the practice of certified registered nurse anesthesia as defined by and in accordance with -.-. LC000 - Page of
3 () The policy or contract currently provides benefits for identical services rendered by a () The certified registered nurse anesthetist is not a salaried employee of the licensed hospital or facility for which the nonprofit hospital service corporation 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 nonprofit hospital service corporation as to which certified registered nurse anesthetists it shall contract with. Reimbursement shall be provided according to the respective principles and policies of the nonprofit hospital service corporation; provided, that no nonprofit hospital service corporation may be required to pay for health care provider. Nothing contained in this section shall preclude the nonprofit hospital service corporation from conducting managed care, medical necessity or utilization review. SECTION. Section -0- of the General Laws in Chapter -0 entitled "Nonprofit Medical Service Corporations" is hereby amended to read as follows: -0-. Third party reimbursement for services of certain health care workers. -- (a) Every individual or group health insurance contract, plan or policy delivered, issued or renewed by an insurer or nonprofit or for profit health service corporation which 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: -.-(c), which requires substantial specialized knowledge, judgment and skill related to the administering anesthetics; monitoring patients during anesthesia; management of fluids in LC000 - Page of
4 intravenous therapy and management of respiratory care; adheres to the practice of certified registered nurse anesthesia as defined by and in accordance with -.-. () The policy or contract currently provides benefits for identical services rendered by a () The certified registered nurse anesthetist is not a salaried employee of the licensed hospital or facility for which the nonprofit medical service corporation 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 nonprofit medical service corporation as to which certified registered nurse anesthetists it shall contract with. Reimbursement shall be provided according to the respective principles and policies of the nonprofit medical service corporation; provided, that no nonprofit medical service corporation may be required to pay for health care provider. Nothing contained in this section shall preclude the nonprofit medical service corporation from conducting managed care, medical necessity or utilization review. SECTION. Section -1- of the General Laws in Chapter -1 entitled "Health Maintenance Organizations" is hereby amended to read as follows: -1-. Third party reimbursement for services of certain health care 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 which 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: LC000 - Page of
5 (c), which requires substantial specialized knowledge, judgment and skill related to the administering anesthetics; monitoring patients during anesthesia; management of fluids in intravenous therapy and management of respiratory care; adheres to the practice of certified registered nurse anesthesia as defined by and in accordance with -.-. () The policy or contract currently provides benefits for identical services rendered by a () 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 health care provider. Nothing contained in this section shall preclude the health maintenance organization from conducting managed care, medical necessity or utilization review. SECTION. This act shall take effect upon passage. LC000 LC000 - Page of
6 EXPLANATION BY THE LEGISLATIVE COUNCIL OF A N A C T RELATING TO INSURANCE - HEALTH MAINTENANCE ORGANIZATIONS *** 1 This act would prohibit a group health plan and a health insurance issuer from discriminating with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider's license or certification under applicable state law. This act would take effect upon passage. LC000 LC000 - Page of
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