reglab/housing_qa huggingface dataset:
RI Gen L § 27-19-42 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-19 - Nonprofit Hospital Service Corporations|Section 27-19-42 - Drug coverage.

§ 27-19-42. Drug coverage.(a) Any nonprofit hospital-service corporation that utilizes a formulary of medications for which coverage is provided under an individual or group plan master contract shall require any physician or other person authorized by the department of health to prescribe medication to prescribe from the formulary. A physician or other person authorized by the department of health to prescribe medication shall be allowed to prescribe medications previously on, or not on, the nonprofit hospital-service corporation's formulary if he or she believes that the prescription of the non-formulary medication is medically necessary. A nonprofit hospital-service corporation shall be required to provide coverage for a non-formulary medication only when the non-formulary medication meets the nonprofit hospital-service corporation's medical-exception criteria for the coverage of that medication.(b) A nonprofit hospital-service corporation's medical-exception criteria for the coverage of non-formulary medications shall be developed in accordance with § 23-17.13-3(c)(3) [repealed].(c) Any subscriber who is aggrieved by a denial of benefits to be provided under this section may appeal the denial in accordance with the rules and regulations promulgated by the department of health pursuant to chapter 17.12 of title 23 [repealed].(d) Prior to removing a prescription drug from its plan's formulary or making any change in the preferred or tiered cost-sharing status of a covered prescription drug, a nonprofit hospital-service corporation must provide at least thirty (30) days' notice to authorized prescribers by established communication methods of policy and program updates and by updating available references on web-based publications. All adversely affected members must be provided at least thirty (30) days' notice prior to the date such change becomes effective by a direct notification:(i) The written or electronic notice must contain the following information:(A) The name of the affected prescription drug;(B) Whether the plan is removing the prescription drug from the formulary, or changing its preferred or tiered, cost-sharing status; and(C) The means by which subscribers may obtain a coverage determination or medical exception, in the case of drugs that will require prior authorization or are formulary exclusions respectively.(ii) A nonprofit hospital-service corporation may immediately remove from its plan formularies covered prescription drugs deemed unsafe by the nonprofit hospital-service corporation or the Food and Drug Administration, or removed from the market by their manufacturer, without meeting the requirements of this section.History of Section.P.L. 1998, ch. 290, § 2; P.L. 2016, ch. 541, § 2; P.L. 2017, ch. 274, § 2; P.L. 2017, ch. 361, § 2.
RI Gen L § 27-19-43 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-19 - Nonprofit Hospital Service Corporations|Section 27-19-43 - Restricted annual rate payments prohibited.

§ 27-19-43. Restricted annual rate payments prohibited.(a) No corporation organized under this chapter shall compensate any provider of outpatient 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, § 2.
RI Gen L § 27-19-44.1 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-19 - Nonprofit Hospital Service Corporations|Section 27-19-44.1 - Genetic information.

§ 27-19-44.1. 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 the individual from whom the information was obtained, except in a format by which 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, § 4; P.L. 2001, ch. 54, § 4; P.L. 2002, ch. 292, § 37.
RI Gen L § 27-19-45 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-19 - Nonprofit Hospital Service Corporations|Section 27-19-45 - Repealed.

§ 27-19-45. Repealed.
RI Gen L § 27-19-47 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-19 - Nonprofit Hospital Service Corporations|Section 27-19-47 - Acupuncture services.

§ 27-19-47. 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.(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 remains within the sole discretion of the non-profit hospital service corporation as to which doctor of acupuncture it shall contract with. Reimbursement is provided according to the respective principles and policies of the non-profit hospital service corporation; provided, that no non-profit hospital service corporation is required to pay for duplicative services actually rendered by a doctor of acupuncture and any other health care provider. Nothing contained in this section precludes the non-profit hospital service corporations from conducting managed care, medical necessity or utilization review.History of Section.P.L. 1999, ch. 288, § 2.
RI Gen L § 27-19-48 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-19 - Nonprofit Hospital Service Corporations|Section 27-19-48 - F.D.A. approved prescription contraceptive drugs and devices.

§ 27-19-48. F.D.A. approved prescription contraceptive drugs and devices.(a) Every individual or group health insurance contract, plan, or policy that provides prescription coverage and is delivered, issued for delivery, or renewed in this state shall provide coverage for F.D.A. approved contraceptive drugs and devices requiring a prescription. Provided, that nothing in this subsection shall be deemed to mandate or require coverage for the prescription drug RU 486.(b) Notwithstanding any other provision of this section, any hospital service corporation may issue to a religious employer an individual or group health insurance contract, plan, or policy that excludes coverage for prescription contraceptive methods that are contrary to the religious employer's bona fide religious tenets.(c) As used in this section, "religious employer" means an employer that is a "church or a qualified church-controlled organization" as defined in 26 U.S.C. § 3121.(d) Every religious employer that invokes the exemption provided under this section shall provide written notice to prospective enrollees prior to enrollment with the plan, listing the contraceptive healthcare services the employer refuses to cover for religious reasons.(e) Beginning on the first day of each plan year after April 1, 2019, every health insurance issuer offering group or individual health insurance coverage that covers prescription contraception shall not restrict reimbursement for dispensing a covered prescription contraceptive up to three hundred sixty-five (365) days at a time.History of Section.P.L. 2000, ch. 120, § 2; P.L. 2000, ch. 126, § 2; P.L. 2002, ch. 292, § 37; P.L. 2018, ch. 230, § 4; P.L. 2018, ch. 234, § 4.
RI Gen L § 27-19-49 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-19 - Nonprofit Hospital Service Corporations|Section 27-19-49 - Prostate and colorectal examinations - Coverage mandated.

§ 27-19-49. Prostate and colorectal examinations — Coverage mandated — The Maryellen Goodwin Colorectal Cancer Screening Act. (a) Subscribers to any nonprofit hospital service corporation plan shall be afforded coverage under the plan for prostate and colorectal examinations and laboratory tests for cancer for any nonsymptomatic person covered under the policy or plan. The coverage required by this section shall include preventive colorectal cancer screening coverage for all colorectal cancer examinations and laboratory tests in accordance with American Cancer Society guidelines, including for colorectal cancer screening of average risk individuals, including an initial colonoscopy or other medical test or procedure for colorectal cancer screening and a follow-up colonoscopy if the results of the initial medical test or procedure are abnormal.(b) An insurer or the corporation may not impose cost sharing on the coverage required by subsection (a) when the services are delivered within the health insurer's provider network.History of Section.P.L. 2000, ch. 125, § 2; P.L. 2000, ch. 345, § 2; P.L. 2021, ch. 7, § 3, effective April 29, 2021; P.L. 2021, ch. 8, § 3, effective April 29, 2021.
RI Gen L § 27-19-51 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-19 - Nonprofit Hospital Service Corporations|Section 27-19-51 - Hearing aids.

§ 27-19-51. Hearing aids.(a) (1) Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state on or after January 1, 2006, shall provide coverage for one thousand five hundred dollars ($1,500) per individual hearing aid, per ear, every three (3) years for anyone under the age of nineteen (19) years, and shall provide coverage for seven hundred dollars ($700) per individual hearing aid per ear, every three (3) years for anyone of the age of nineteen (19) years and older.(2) Every group health insurance contract or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state on or after January 1, 2006, shall provide, as an optional rider, additional hearing aid coverage. Provided, the provisions of this paragraph shall not apply to contracts, plans, or group policies subject to the small employer health insurance availability act, chapter 50 of this title.(b) For the purposes of this section, "hearing aid" means any nonexperimental, wearable instrument or device designed for the ear and offered for the purpose of aiding or compensating for impaired human hearing, but excluding batteries, cords, and other assistive listening devices, including, but not limited to, FM systems.(c) It shall remain within the sole discretion of the nonprofit hospital service corporation as to the provider of hearing aids with which they choose to contract. Reimbursement shall be provided according to the respective principles and policies of the nonprofit hospital service corporation. Nothing contained in this section precludes the nonprofit hospital service corporation from conducting managed care, medical necessity, or utilization review.History of Section.P.L. 2000, ch. 461, § 2; P.L. 2004, ch. 539, § 2; P.L. 2004, ch. 550, § 2; P.L. 2005, ch. 374, § 2; P.L. 2005, ch. 395, § 2; P.L. 2006, ch. 595, § 2; P.L. 2006, ch. 614, § 2.
RI Gen L § 27-19-53 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-19 - Nonprofit Hospital Service Corporations|Section 27-19-53 - Mandatory coverage for certain lyme disease treatments.

§ 27-19-53. Mandatory coverage for certain lyme disease treatments.Every individual or group hospital or medical expense insurance policy or individual or group hospital or medical services plan contract delivered, issued for delivery, or renewed in this state on or after January 1, 2004 shall provide coverage for diagnostic testing and long term antibiotic treatment of chronic lyme disease when determined to be medically necessary and ordered by a physician acting in accordance with chapter 37.5 of title 5 entitled "lyme disease diagnosis and treatment" after making a thorough evaluation of the patient's symptoms, diagnostic test results and response to treatment. Treatment otherwise eligible for benefits pursuant to this section shall not be denied solely because such treatment may be characterized as unproven, experimental, or investigational in nature.History of Section.P.L. 2003, ch. 113, § 4; P.L. 2003, ch. 114, § 4; P.L. 2004, ch. 34, § 3; P.L. 2004, ch. 35, § 3.
RI Gen L § 27-19-54 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-19 - Nonprofit Hospital Service Corporations|Section 27-19-54 - Dental insurance assignment of benefits.

§ 27-19-54. Dental insurance assignment of benefits.Every entity providing a contract of insurance subject to this chapter shall allow, as a provision in a group or individual policy, contract or health benefit plan for coverage of dental services, any person insured by such entity to direct, in writing, that benefits from a health benefit plan, policy or contract, be paid directly to a dental care provider who has not contracted with the entity to provide dental services to persons covered by the entity but otherwise meets the credentialing criteria of the entity and has not previously been terminated by such entity as a participating provider. If written direction to pay is executed and written notice of the direction to pay is provided to such entity, the insuring entity shall pay the benefits directly to the dental care provider. Any efforts to modify the amount of benefits paid directly to the dental care provider under this section may include a reduction in benefits paid of no more than five percent (5%) less than the benefits paid to participating dentists. The entity paying the dentist, pursuant to a direction to pay duly executed by the subscriber, shall have the right to review the records of the dentist receiving such payment that relate exclusively to that particular subscriber/patient to determine that the service in question was rendered.History of Section.P.L. 2004, ch. 268, § 2; P.L. 2004, ch. 386, § 2.
RI Gen L § 27-19-55 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-19 - Nonprofit Hospital Service Corporations|Section 27-19-55 - Coverage for early intervention services.

§ 27-19-55. Coverage for early intervention services.(a) Every individual or group hospital or medical expense insurance policy or contract providing coverage for dependent children, delivered or renewed in this state on or after July 1, 2004, shall include coverage of early intervention services which coverage shall take effect no later than January 1, 2005. Such coverage shall be limited to a benefit of five thousand dollars ($5,000) per dependent child per policy or calendar year and shall not be subject to deductibles and coinsurance factors. Any amount paid by an insurer under this section for a dependent child shall not be applied to any annual or lifetime maximum benefit contained in the policy or contract. For the purpose of this section, "early intervention services" means, but is not limited to, speech and language therapy, occupational therapy, physical therapy, evaluation, case management, nutrition, service plan development and review, nursing services, and assistive technology services and devices for dependents from birth to age three (3) who are certified by the department of human services as eligible for services under part C of the Individuals with Disabilities Education Act (20 U.S.C. § 1471 et seq.).(b) Subject to the annual limits provided in this section, insurers shall reimburse certified early intervention providers, who are designated as such by the Department of Human Services, for early intervention services as defined in this section at rates of reimbursement equal to or greater than the prevailing integrated state/Medicaid rate for early intervention services as established by the Department of Human Services.(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. 2004, ch. 595, art. 22, § 2; P.L. 2004, ch. 598, § 3; P.L. 2005, ch. 97, § 2; P.L. 2005, ch. 99, § 2; P.L. 2008, ch. 475, § 83.
RI Gen L § 27-19-56 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-19 - Nonprofit Hospital Service Corporations|Section 27-19-56 - Post-payment audits.

§ 27-19-56. Post-payment audits.(a) Except as otherwise provided herein, any review, audit, or investigation by a nonprofit hospital service corporation of a healthcare provider's claims that results in the recoupment or set-off of funds previously paid to the healthcare provider in respect to such claims shall be completed no later than eighteen (18) months after the completed claims were initially paid. This section shall not restrict any review, audit, or investigation regarding claims that are submitted fraudulently; are known, or should have been known, by the healthcare provider to be a pattern of inappropriate billing according to the standards for provider billing of their respective medical or dental specialties; are related to coordination of benefits; are duplicate claims; or are subject to any federal law or regulation that permits claims review beyond the period provided herein.(b) No healthcare provider shall seek reimbursement from a payer for underpayment of a claim later than eighteen (18) months from the date the first payment on the claim was made, except if the claim is the subject of an appeal properly submitted pursuant to the payer's claims appeal policies or the claim is subject to continual claims submission.(c) For the purposes of this section, "healthcare provider" means an individual clinician, either in practice independently or in a group, who provides healthcare services, and any healthcare facility, as defined in § 27-18-1.1, including any mental health and/or substance abuse treatment facility, physician, or other licensed practitioner identified to the review agent as having primary responsibility for the care, treatment, and services rendered to a patient.(d) Except for those contracts where the health insurer or plan has the right to unilaterally amend the terms of the contract, the parties shall be able to negotiate contract terms that allow for different time frames than is prescribed herein.History of Section.P.L. 2006, ch. 86, § 2; P.L. 2006, ch. 97, § 2; P.L. 2013, ch. 251, § 2; P.L. 2013, ch. 395, § 2; P.L. 2014, ch. 201, § 2; P.L. 2014, ch. 214, § 2; P.L. 2017, ch. 368, § 2; P.L. 2017, ch. 375, § 2.