TITLE 27
Insurance
CHAPTER 27-19
Nonprofit Hospital Service Corporations
SECTION 27-19-40
§ 27-19-40 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 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 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 duplicative services actually rendered by a certified
registered nurse anesthetist and any other health care provider. Nothing
contained in this section shall preclude the nonprofit hospital service
corporation 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.
History of Section.
(P.L. 1997, ch. 345, § 2; P.L. 1997, ch. 365, § 2; P.L. 2002, ch.
292, § 37; P.L. 2015, ch. 205, § 2; P.L. 2015, ch. 223, §
2.)