reglab/housing_qa huggingface dataset:
RI Gen L § 27-18-43 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-18 - Accident and Sickness Insurance Policies|Section 27-18-43 - Pap smears - Quality assurance standards.

§ 27-18-43. Pap smears — Quality assurance standards.A pap smear eligible for reimbursement under § 27-18-41 shall be reimbursed only if the laboratory in which the pap smear is processed is licensed by the department of health specifically to perform cervical cytology, or is accredited by the American Society of Cytology, or is accredited by the College of American Pathologists, or is a hospital accredited by the joint commission on accreditation health care organizations or the American Osteopathic Association at the time the pap smear is processed.History of Section.P.L. 1997, ch. 76, § 1.
RI Gen L § 27-18-45 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-18 - Accident and Sickness Insurance Policies|Section 27-18-45 - Whistleblowers protection.

§ 27-18-45. Whistleblowers protection.No accident and sickness insurer pursuant to this chapter, or any other insurer offering and/or insuring health services on a prepaid basis as defined in § 42-62-4(7), shall engage in any retaliation or retribution, directly or indirectly, or shall terminate or modify the terms of a medical service agreement that it maintains with a physician or other medical services provider, because the physician or other provider reports or is about to report verbally or in writing, to a public body, a regulatory agency, a subscriber or member of the insured, the family or heirs or personal representative of the subscriber or member or to any other person or public or private agency a violation by the insurer of a subscriber or membership agreement, a law, rule or regulation promulgated under the laws of this state.History of Section.P.L. 1997, ch. 167, § 1.
RI Gen L § 27-18-46 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-18 - Accident and Sickness Insurance Policies|Section 27-18-46 - Penalties and remedies.

§ 27-18-46. Penalties and remedies.(a) Any person, firm, corporation, association or other legal entity who or which shall violate the provisions of § 27-18-45 shall be guilty of a misdemeanor, and upon conviction, shall be fined in an amount of not more than one thousand dollars ($1,000), imprisonment for up to one year, or by both fine and imprisonment.(b) In addition to the criminal sanctions set forth in subsection (a) of this section, any person, firm, corporation, association or other legal entity who or which shall willfully or negligently violate any provision of this chapter shall be subject to a civil penalty, to be assessed by the insurance commissioner, in the maximum amount of five thousand dollars ($5,000) for each violation, and each violation shall constitute a separate and distinct offense under this section.History of Section.P.L. 1997, ch. 167, § 1.
RI Gen L § 27-18-47 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-18 - Accident and Sickness Insurance Policies|Section 27-18-47 - Additional relief and damages - Reinstatement.

§ 27-18-47. Additional relief and damages — Reinstatement.(a) A physician or other medical provider who alleges a violation of this act may bring a civil action for appropriate injunctive relief, actual and punitive damages and costs including reasonable attorney fees.(b) An action commenced pursuant to this chapter may be brought in the superior court for the county where the alleged violation occurred, the county where the complainant resides or the county in which the insurer maintains its principal place of business.(c) The court rendering a judgment in an action under this act shall order, as the court considers appropriate, reinstatement of the provider agreement.History of Section.P.L. 1997, ch. 167, § 1.
RI Gen L § 27-18-48 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-18 - Accident and Sickness Insurance Policies|Section 27-18-48 - Third party reimbursement for services of certain healthcare workers.

§ 27-18-48. Third party reimbursement for services of certain healthcare workers.(a) Every individual or group hospital or medical services plan contract delivered, issued or renewed by an insurer or 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 accident and sickness insurer 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 healthcare 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 healthcare 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 healthcare 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, § 1; P.L. 1997, ch. 365, § 1; P.L. 2002, ch. 292, § 33; P.L. 2015, ch. 205, § 1; P.L. 2015, ch. 223, § 1.
RI Gen L § 27-18-48.1 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-18 - Accident and Sickness Insurance Policies|Section 27-18-48.1 - Third party reimbursement for services of registered nurse first assistants.

§ 27-18-48.1. Third party reimbursement for services of registered nurse first assistants.(a) Every individual or group hospital or medical services plan contract delivered, issued or renewed by an insurer or nonprofit 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 designated as a registered nurse first assistant provided, however, 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 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 accident and sickness insurer has an alternative contractual relationship to fund the services of a registered nurse first assistant.(b) It shall remain within the sole discretion of the accident and sicknesses insurer as to which registered nurse first assistant it shall contract with. Reimbursement shall be provided according to the respective principles and policies of the health maintenance organization; provided, however, that no accident and sicknesses insurer may be 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 shall preclude the health maintenance organization from conducting managed care, medical necessity or utilization review.(c) This section shall not apply to insurance coverage providing benefits for: (1) hospital confinement indemnity; (2) disability income; (3) accident only; (4) long term care; (5) Medicare supplement; (6) limited benefit health; (7) specified disease indemnity; (8) sickness or bodily injury or death by accident or both; and (9) other limited benefit policies.History of Section.P.L. 1999, ch. 509, § 1; P.L. 2002, ch. 292, § 33.
RI Gen L § 27-18-49 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-18 - Accident and Sickness Insurance Policies|Section 27-18-49 - Human leukocyte antigen testing.

§ 27-18-49. Human leukocyte antigen testing.(a) Every individual or group hospital or medical services plan contract delivered or renewed in this state shall include coverage of the cost for human leukocyte antigen testing, also referred to as histocompatibility locus antigen testing, for A, B, and DR antigens for utilization in bone marrow transplantation. The testing must be performed in a facility that is accredited by the American Association of Blood Banks or its successors, and is licensed under the Clinical Laboratory Improvement Act, 42 U.S.C. § 263a, as it may be from time to time amended. At the time of the testing, the person being tested must complete and sign an informed consent form that also authorizes the results of the test to be used for participation in the National Marrow Donor Program. The group hospital or medical services plan contract may limit each subscriber to one of these testings per lifetime.(b) This section shall not apply to insurance coverage providing benefits for: (1) hospital confinement indemnity; (2) disability income; (3) accident only; (4) long term care; (5) Medicare supplement; (6) limited benefit health; (7) specified disease indemnity; (8) sickness or bodily injury or death by accident or both; and (9) other limited benefit policies.History of Section.P.L. 1998, ch. 8, § 1; P.L. 1998, ch. 9, § 1; P.L. 2002, ch. 292, § 33.
RI Gen L § 27-18-50.1 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-18 - Accident and Sickness Insurance Policies|Section 27-18-50.1 - Medication synchronization.

§ 27-18-50.1. Medication synchronization.(a) An individual or group health insurance plan or policy delivered, issued for delivery, or renewed in this state on or after January 1, 2017, providing prescription drug coverage in the state, must permit and apply a prorated, daily cost-sharing rate to covered prescriptions for a chronic condition that are dispensed by an in-network pharmacy for less than a thirty (30) days' supply if the prescriber and pharmacist determine the fill or refill to be in the best interest of the patient for the management or treatment of a chronic, long-term care condition and the patient requests or agrees to less than a thirty (30) days' supply for the purpose of synchronizing the patient's medications and the insured's or enrollee's maintenance prescription drug(s) to be synchronized meets all of the following requirements:(1) Is covered by the policy, certificate, or contract described in this chapter;(2) Is used for the management and treatment of a chronic, long-term care condition and have authorized refills that remain available to the insured or enrollee;(3) Except as otherwise provided in this subparagraph, is not a controlled substance included in schedules II to V;(4) Meets all utilization management requirements specific to the maintenance-prescription drugs at the time of the request to synchronize the insured's or enrollee's multiple, maintenance-prescription drugs;(5) Is of a formulation that can be effectively split over required short-fill periods to achieve synchronization; and(6) Does not have quantity limits or dose-optimization criteria or requirements that will be violated when synchronizing the insured's or enrollee's multiple, maintenance-prescription drugs.(b) The plan or policy described in subsection (a) shall apply a prorated, daily cost-sharing rate for maintenance-prescription drugs that are dispensed by an in-network pharmacy for the purpose of synchronizing the insured's or enrollee's multiple, maintenance-prescription drugs.(c) The plan or policy described in subsection (a) shall not reimburse or pay any dispensing fee that is prorated. The insurer shall only pay or reimburse a dispensing fee that is based on each maintenance-prescription drug dispensed.(d) A synchronization shall only occur once per year per maintenance-prescription drug.History of Section.P.L. 2016, ch. 179, § 1; P.L. 2016, ch. 196, § 1.
RI Gen L § 27-18-51 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-18 - Accident and Sickness Insurance Policies|Section 27-18-51 - Restricted annual rate payments prohibited.

§ 27-18-51. Restricted annual rate payments prohibited.(a) No policy delivered or issued in this state shall contain a provision for compensating any provider of outpatient mental health and/or substance abuse treatment service by using the restricted annual rate method of payment.(b) The restricted annual rate method of payment is defined as any method of payment that sets, as all or part of its payment scheme, a total payment limit for mental health and/or substance abuse treatment services for each person seeking treatment based on a per person per unit of time criterion that disregards the extent of treatment and/or degree of services rendered.(c) This prohibition shall not be construed to prohibit or limit capitation or other risk sharing agreements between providers and insurers otherwise permissible by law.History of Section.P.L. 1998, ch. 352, § 1.
RI Gen L § 27-18-52.1 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-18 - Accident and Sickness Insurance Policies|Section 27-18-52.1 - Genetic information.

§ 27-18-52.1. Genetic information.(a) Except as provided in chapter 37.3 of title 5, insurance administrators, health plans and providers shall be prohibited from releasing genetic information without prior written authorization of the individual. Written authorization shall be required for each disclosure and include to whom the disclosure is being made. An exception shall exist for those participating in research settings governed by the Federal Policy for the Protection of Human Research Subjects (also known as "The Common Rule"). Tests conducted purely for research are excluded from the definition, as are tests for somatic (as opposed to heritable) mutations, and testing for forensic purposes.(b) No individual or group health insurance contract, plan, or policy delivered, issued for delivery, or renewed in this state, which provides medical coverage that includes coverage for physician services in a physician's office, and every policy which provides major medical or similar comprehensive-type coverage excluding disability income, long term care and insurance supplemental policies which only provide coverage for specified diseases or other supplemental policies, shall:(1) Use genetic information or request for genetic information or the results of genetic information or other genetic information to reject, deny, limit, cancel, refuse to renew, increase the rates of, affect the terms or conditions of, or otherwise affect a group or an individual's health insurance policy, contract, or plan;(2) Request or require genetic information for the purpose of determining whether or not to issue or renew an individual's health benefits coverage, to set reimbursement/co-pay levels or determine covered benefits and services;(3) Release the results of genetic information without the prior written authorization of an individual from whom the information was obtained, except in a format where individual identifiers are removed, encrypted, or encoded so that the identity of the individual is not disclosed. A recipient of information pursuant to this section may use or disclose the information solely to carry out the purpose for which the information was disclosed. Authorization shall be required for each redisclosure. An exception shall exist for participation in research settings governed by the Federal Policy for the Protection of Human Research Subjects (also known as "The Common Rule");(4) Request or require information as to whether an individual has genetic information, or participated in genetic information of any kind, whether for clinical or research purposes.(c) For the purposes of this section, "genetic information" is information about genes, gene product, or inherited characteristics that may derive from the individual or a family member.History of Section.P.L. 2001, ch. 38, § 2; P.L. 2001, ch. 54, § 2; P.L. 2002, ch. 292, § 33.
RI Gen L § 27-18-54 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-18 - Accident and Sickness Insurance Policies|Section 27-18-54 - Health insurance rates.

§ 27-18-54. Health insurance rates.No insurance company organized as a stock or mutual corporation which merges or consolidates with, acquires ownership or control or possession of twenty percent (20%) or greater of the operating assets of, or otherwise acquires control of a non-profit hospital service corporation organized under chapter 19 of this title, a non-profit medical service corporation organized under chapter 20 of this title or a health maintenance organization organized under chapter 41 of this title may: (1) file with any state agency for review or approval any proposed rate to be used by the company in the state, or (2) charge to any party in the state any rate or premium, which takes into account or reflects in any manner the value of any contribution, distribution or allocation the company expends or incurs in establishing or funding a charitable foundation organized to maintain or account for the assets of a non-profit hospital service corporation, non-profit medical service corporation or health maintenance organization. For any rate that is to be charged to policy holders, regardless of whether the rate is subject to approval by a state agency under this or another chapter, the company shall at least thirty (30) days before implementing the rate submit under oath to the commissioner of insurance an accounting that documents the cost structure on which the rate is based and demonstrates the company's compliance with this section.History of Section.P.L. 1999, ch. 215, § 2; P.L. 1999, ch. 376, § 2.
RI Gen L § 27-18-55 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-18 - Accident and Sickness Insurance Policies|Section 27-18-55 - Acupuncture services.

§ 27-18-55. Acupuncture services.(a) Every group health insurance contract, plan, or group policy delivered, issued for delivery or renewed in this state which provides medical coverage, and every group policy which provides for treatment of persons for the prevention, cure or correction of any illness or physical or mental condition, shall provide, as an optional rider, coverage for the services of a doctor of acupuncture as a provider of acupuncture services; provided, that this section shall not apply to insurance coverage providing benefits for: (1) hospital confinement indemnity; (2) disability income; (3) accident only; (4) long term care; (5) Medicare supplement; (6) limited benefit health; (7) specified disease indemnity; (8) sickness or bodily injury or death by accident or both; and (9) other limited benefit policies.(b) For the purposes of this section:(1) "Doctor of acupuncture" means a practitioner licensed under chapter 37.2 of title 5.(2) "Coverage for the services of a doctor of acupuncture as a provider of acupuncture services" means coverage for acupuncture as defined in § 5-37.2-2(1).(c) It shall remain within the sole discretion of the accident and sickness insurer as to which doctor of acupuncture it shall contract with. Reimbursement shall be provided according to the respective principles and policies of the accident and sickness insurer; provided, that no accident and sickness insurer may be required to pay for duplicative services actually rendered by a doctor of acupuncture and any other health care provider. Nothing contained in this section shall preclude the accident and sickness insurer from conducting managed care, medical necessity or utilization review.History of Section.P.L. 1999, ch. 288, § 1.
RI Gen L § 27-18-56 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-18 - Accident and Sickness Insurance Policies|Section 27-18-56 - Prohibition against dentists being required to indemnify provider.

§ 27-18-56. Prohibition against dentists being required to indemnify provider.No accident and sickness insurance provider may contract to require that a dentist indemnify or hold harmless the accident and sickness insurance provider 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 accident and sickness insurance provider based on the accident and sickness insurance provider's management decisions or utilization review provisions for any patient.History of Section.P.L. 1999, ch. 481, § 1.