§27-41-49  Third party reimbursement for services of certain health care workers. –


Published: 2015

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TITLE 27

Insurance

CHAPTER 27-41

Health Maintenance Organizations

SECTION 27-41-49



   § 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;

and



   (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

measures.



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, §

4.)

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