TITLE 27

Insurance

CHAPTER 27-41

Health Maintenance Organizations

SECTION 27-41-39



   § 27-41-39  Certified registered nurse

practitioners and psychiatric and mental health nurse clinical specialists.

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(a) Every individual or group policy or contract delivered, issued for

delivery, or renewed by a health maintenance organization in this state shall

provide coverage for the services of certified registered nurse practitioners,

practicing collaboratively and psychiatric and mental health nurse clinical

specialists to subscribers, if those services are within the certified

registered nurse practitioner's or psychiatric and mental health nurse clinical

specialist's area of professional competence as established by education and

certification, and are currently reimbursed when rendered by any other health

care provider. No health maintenance organization may be required to pay for

duplicative services actually rendered by a certified nurse practitioner and

any other health care provider.



   (b) Nothing in this chapter shall preclude the conducting of

managed care reviews and medical necessity reviews by an insurer or hospital or

medical service corporation or health maintenance organization.



   (c) Every individual or group policy or contract delivered,

issued for delivery, or renewed by a health maintenance organization in this

state shall provide coverage for certified registered nurse practitioners to

provide primary care, intermediate, home, long-term and inpatient care as

primary care providers, when said certified registered nurse practitioner is a

participating provider, consistent with, and practicing within, the scope of

his/her professional license.



   (d) Notwithstanding any law to the contrary, all insurers,

nonprofit medical service corporations, nonprofit hospital service corporations

and health maintenance organizations shall provide subscribers with an

opportunity to select a certified registered nurse practitioner, who is a

participating provider, as a primary care provider.



   (e) Notwithstanding any law to the contrary, all insurers,

nonprofit medical service corporations, nonprofit hospital service corporations

and health maintenance organizations shall insure that all participating

primary care provider certified registered nurse practitioners are included on

any publicly accessible list of participating providers for the respective

organization.



History of Section.

(P.L. 1991, ch. 361, § 4; P.L. 1994, ch. 90, § 3; P.L. 2002, ch. 292,

§ 85; P.L. 2009, ch. 351, § 3; P.L. 2009, ch. 352, §

3.)