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§27-20-35.1  Third party reimbursement for services of registered nurse first assistants. –


Published: 2015

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TITLE 27

Insurance

CHAPTER 27-20

Nonprofit Medical Service Corporations

SECTION 27-20-35.1



   § 27-20-35.1  Third party reimbursement for

services of registered nurse first assistants. –

(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

registered nurse first assistant, provided, that the following conditions are

met:



   (1) The registered nurse first assistant provides certain

health care services under the supervision of a licensed physician; is

currently licensed as a registered nurse in Rhode Island; has successfully

completed a course in preparing the registered nurse as a first assistant in

accordance with the Association of Operating Room Nurses core curriculum guide

for the registered nurse first assistant and includes a minimum of one academic

year in a college or university with didactic instruction and clinical

internship programs; and is certified in perioperative nursing by the

Certification Board of Perioperative Nursing (minimum of two years

perioperative experience);



   (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 registered nurse first assistant 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 registered nurse first assistant.



   (b) It remains within the sole discretion of the nonprofit

medical service corporation as to which registered nurse first assistant in

surgery it contracts with. Reimbursement is provided according to the

respective principles and policies of the nonprofit medical service

corporation: provided, that no nonprofit medical service corporation is

required to provide direct reimbursement, or pay for duplicative services

actually rendered by a registered nurse first assistant and any other health

care provider. Nothing contained in this section precludes the nonprofit

medical service corporations from conducting managed care, medical necessity or

utilization review.



History of Section.

(P.L. 1999, ch. 509, § 3; P.L. 2002, ch. 292, § 39.)