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§27-19-40  Third-party reimbursement for services of certain health care workers. –


Published: 2015

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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.)