Health Maintenance Organizations
§ 27-41-49 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, health maintenance organization,
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;
(3) The certified registered nurse anesthetist 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 certified registered nurse anesthetist.
(b) It shall remain within the sole discretion of the health
maintenance organization as to which certified registered nurse anesthetists it
shall contract with. Reimbursement shall be provided according to the
respective principles and policies of the health maintenance organization;
provided, that no health maintenance organization 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 health maintenance organization 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
History of Section.
(P.L. 1997, ch. 345, § 4; P.L. 1997, ch. 365, § 4; P.L. 2002, ch.
292, § 85; P.L. 2015, ch. 205, § 4; P.L. 2015, ch. 223, §