Rhode Island General Laws 27-41-14.1. Prohibition against restraint on provider – Patient communications
No health maintenance organization shall refuse to contract with or compensate for covered services an otherwise eligible health care provider solely because the provider has in good faith communicated with one or more of his or her current, former or prospective patients regarding the provisions, terms, requirements, restrictions or other treatment options not provided by the health maintenance organization and of the health maintenance organization’s products and/or services as they relate to the needs of the provider’s patients. By way of illustration only, and without limiting the protections afforded in this section, the communications within this section may involve hospital stays, emergency room use, and referral to specialists. Any provision contained in any contract between a health maintenance organization and a health care provider which violates the provisions of this section shall be null and void, and any attempt by a health maintenance organization to enforce that provision shall subject the health maintenance organization to assessment of a penalty of up to five thousand dollars ($5,000). These penalties shall be enforced by the consumer protection division of the department of the attorney general in the district court.
History of Section.
P.L. 1997, ch. 352, § 1.
Terms Used In Rhode Island General Laws 27-41-14.1
- Contract: A legal written agreement that becomes binding when signed.
- Health maintenance organization: means a single public or private organization which:
(1) Provides or makes available to enrolled participants healthcare services, including at least the following basic healthcare services: usual physician services, hospitalization, laboratory, x-ray, emergency, and preventive services, and out of area coverage, and the services of licensed midwives;
(2) Is compensated, except for copayments, for the provision of the basic healthcare services listed in subdivision (1) of this subsection to enrolled participants on a predetermined periodic rate basis; and
(3)(i) Provides physicians' services primarily:
(A) Directly through physicians who are either employees or partners of the organization; or
(B) Through arrangements with individual physicians or one or more groups of physicians organized on a group practice or individual practice basis;
(ii) "Health maintenance organization" does not include prepaid plans offered by entities regulated under chapter 1, 2, 19, or 20 of this title that do not meet the criteria above and do not purport to be health maintenance organizations;
(4) Provides the services of licensed midwives primarily:
(i) Directly through licensed midwives who are either employees or partners of the organization; or
(ii) Through arrangements with individual licensed midwives or one or more groups of licensed midwives organized on a group practice or individual practice basis. See Rhode Island General Laws 27-41-2
- provider: means a healthcare professional or a healthcare facility. See Rhode Island General Laws 27-41-2