(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 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:
Terms Used In Rhode Island General Laws 27-18-48. Third party reimbursement for services of certain health care workers
- contract: A legal written agreement that becomes binding when signed.
- corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
- Group health plan: means an employee welfare benefit plan, as defined in 29 USC § 1002(1), to the extent that the plan provides health benefits to employees or their dependents directly or through insurance, reimbursement, or otherwise. See Rhode Island General Laws 27-18-1.1
- provider: means a health care professional or a health care facility. See Rhode Island General Laws 27-18-1.1
(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 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 duplicative services actually rendered by a certified registered nurse anesthetist and any other health care 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 health care 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 health care 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.
(P.L. 1997, ch. 345, § 1; P.L. 1997, ch. 365, § 1; P.L. 2002, ch. 292, § 33; P.L. 2015, ch. 205, § 1; P.L. 2015, ch. 223, § 1.)