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§27-41-49.1  Third party reimbursement for services of registered nurse first assistants. –


Published: 2015

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TITLE 27

Insurance

CHAPTER 27-41

Health Maintenance Organizations

SECTION 27-41-49.1



   § 27-41-49.1  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, health maintenance organization,

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 designed as such;

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 health maintenance

organization has an alternative contractual relationship to fund the services

of a registered nurse first assistant.



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

maintenance organization as to which registered nurse first assistant it

contracts with. Reimbursement provided according to the respective principles

and policies of the health maintenance organization; provided, that no health

maintenance organization 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 health maintenance organization from conducting managed care,

medical necessity or utilization review.



History of Section.

(P.L. 1999, ch. 509, § 4; P.L. 2002, ch. 292, § 85.)