TITLE 27

Insurance

CHAPTER 27-20

Nonprofit Medical Service Corporations

SECTION 27-20-5



   § 27-20-5  Contracts with subscribers.

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Each nonprofit medical service corporation may contract with its subscribers

for any medical service as may be provided under any nonprofit medical service

plan adopted by the corporation; provided, that:



   (1) If any medical service as may be provided for shall

include service which may be lawfully performed or rendered by a podiatrist,

the contract shall provide for the payment for the service so performed or

rendered by a podiatrist;



   (2) If any medical service as may be provided for shall

include service which may be lawfully performed or rendered by a certified

registered nurse practitioner or psychiatric and mental health nurse clinical

specialist, the contract will provide for the payment for the service performed

or rendered by a certified registered nurse practitioner or psychiatric and

mental health nurse clinical specialist to subscribers. No nonprofit medical

service corporation may require supervision, signature, or referral by any

other health care provider as a condition of reimbursement to a certified

registered nurse practitioner; provided, that no nonprofit medical service

corporation may be required to pay for duplicative services actually rendered

by both a certified registered nurse practitioner and any other health care

provider;



   (3) If any medical service as may be provided for shall

include service which may be lawfully performed or rendered by a licensed

midwife, the contract delivered, issued for delivery, or renewed in this state

shall provide for the payment for the service performed or rendered by a

licensed midwife in accordance with each health insurers' respective principles

and mechanisms of reimbursement credentialing and contracting if those services

are within the licensed midwives' area of professional competence as defined by

regulations promulgated pursuant to § 23-13-9, and are currently

reimbursed when rendered by any other licensed health care provider. No

nonprofit medical service corporation may require supervision, signature, or

referral by any other health care provider as a condition of reimbursement

except when the requirements are also applicable to other categories of health

care providers; provided, no insurer or hospital or medical service corporation

or patient may be required to pay for duplicate services actually rendered by

both a licensed midwife and any other health care provider. Direct payment for

licensed midwives will be contingent upon services rendered in a licensed

health care facility and for services rendered in accordance with rules and

regulations promulgated by the department of health; provided, that this

provision shall not prohibit payment for services pursuant to § 42-62-26

or for other services reimbursed by third party payors; and



   (4) If any medical service which may be provided for shall

include service which may be rendered by a counselor in mental health or a

therapist in marriage and family practice, excluding marital and family therapy

unless there is an individual diagnosed with a mental disorder, the contract

shall provide for payment for the service performed or rendered when deemed

medically necessary by the nonprofit medical service corporation in accordance

with its standard medical management protocols and within the nonprofit medical

service corporation's subscriber contractual limits. In the case of a limited

provider network, it shall remain within the sole discretion of the nonprofit

medical service corporation as to which certified counselors in mental health

and certified therapists in marriage and family practice with which it shall

contract. Nothing contained in this subdivision shall require the nonprofit

medical service corporation to provide coverage other than in conjunction with

a related medical illness.



   (5) No contract between a nonprofit medical service

corporation and a dentist for the provisions of services to patients may

require that the dentist indemnify or hold harmless the nonprofit medical

service corporation for any expenses and liabilities, including without

limitation, judgments, settlements, attorneys' fees, court costs, and any

associated charges, incurred in connection with any claim or action brought

against the nonprofit medical service corporation based on the nonprofit

medical service corporation's management decisions, or utilization review

provisions for any patient.



History of Section.

(P.L. 1945, ch. 1598, § 3; G.L. 1956, § 27-20-5; P.L. 1961, ch. 136,

§ 2; P.L. 1990, ch. 168, § 2; P.L. 1991, ch. 361, § 5; P.L.

1994, ch. 89, § 4; P.L. 1999, ch. 481, § 3; P.L. 2002, ch. 292,

§ 39.)