reglab/housing_qa huggingface dataset:
RI Gen L § 27-41-13.3 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-41 - Health Maintenance Organizations|Section 27-41-13.3 - Waiver, surplus notes, and risk based capital requirements.

§ 27-41-13.3. Waiver, surplus notes, and risk based capital requirements.(a) The director may waive any of the net worth and/or total adjusted capital requirements as set forth in §§ 27-41-13.1 or 27-41-13.2 whenever satisfied that the health maintenance organization has sufficient net worth and/or total adjusted capital and an adequate history of generating net income to assure its financial viability for the next year, or its performance and obligations are guaranteed by an organization with sufficient net worth and an adequate history of generating net income, or the assets of the health maintenance organization or its contracts with insurers, hospital or medical service corporations, governments, or other organizations are sufficient to reasonably assure the performance of its obligations; provided, however, that in no event shall the net worth requirement be less than two million five hundred thousand dollars ($2,500,000).(b) (1) Surplus notes. In determining net worth, no debt is considered fully subordinated unless the subordination clause is in a form acceptable to the director. Any interest obligation relating to the repayment of any subordinated debt must be similarly subordinated.(2) The interest expenses relating to the repayment of any fully subordinated debt are considered covered expenses.(3) Any debt incurred by a note meeting the requirements of this section, and otherwise acceptable to the director, are not considered a liability and are recorded as equity.(c) In addition to the net worth and capital requirements of §§ 27-41-13.1 through 27-41-13.3, all requirements of chapter 4.7 of this title shall apply to health maintenance organizations.History of Section.P.L. 2005, ch. 176, § 2.
RI Gen L § 27-41-14.1 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-41 - Health Maintenance Organizations|Section 27-41-14.1 - Prohibition against restraint on provider - Patient communications.

§ 27-41-14.1. Prohibition against restraint on provider — Patient communications.No health maintenance organization shall refuse to contract with or compensate for covered services an otherwise eligible health care provider solely because the provider has in good faith communicated with one or more of his or her current, former or prospective patients regarding the provisions, terms, requirements, restrictions or other treatment options not provided by the health maintenance organization and of the health maintenance organization's products and/or services as they relate to the needs of the provider's patients. By way of illustration only, and without limiting the protections afforded in this section, the communications within this section may involve hospital stays, emergency room use, and referral to specialists. Any provision contained in any contract between a health maintenance organization and a health care provider which violates the provisions of this section shall be null and void, and any attempt by a health maintenance organization to enforce that provision shall subject the health maintenance organization to assessment of a penalty of up to five thousand dollars ($5,000). These penalties shall be enforced by the consumer protection division of the department of the attorney general in the district court.History of Section.P.L. 1997, ch. 352, § 1.
RI Gen L § 27-41-15 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-41 - Health Maintenance Organizations|Section 27-41-15 - Powers of insurers and hospital and medical service corporations.

§ 27-41-15. Powers of insurers and hospital and medical service corporations.An insurance company licensed in this state may either directly or through a subsidiary or affiliate organize and operate a health maintenance organization under the provisions of this chapter. Notwithstanding any other law that may be inconsistent with this section, any two (2) or more state insurance companies, or subsidiaries or affiliates of those companies, may jointly organize and operate a health maintenance organization. A hospital or medical service corporation may own and operate a health maintenance organization. With respect to those corporations, operation of a health maintenance organization shall not be deemed to be participation in the business of insurance. The business of insurance is deemed to include the providing of health care by a health maintenance organization owned or operated by an insurer or a subsidiary of an insurer.History of Section.P.L. 1983, ch. 225, § 2.
RI Gen L § 27-41-16 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-41 - Health Maintenance Organizations|Section 27-41-16 - Examination.

§ 27-41-16. Examination.(a) The director of business regulation may make an examination of the affairs of any health maintenance organization and the providers with whom the organization has contracts, agreements, or other arrangements pursuant to its health care plan as often as is reasonably necessary for the protection of the interests of the people of this state. The examination shall be performed and the associated costs shall be borne by the company in accordance with all the provisions of § 27-13.1.(b) The director of health may make an examination concerning the quality of health care services of any health maintenance organization and the providers with whom the organization has contracts, agreements, or other arrangements as often as is reasonably necessary for the protection of the interests of the people of this state.(c) Each health maintenance organization shall establish and maintain on an ongoing basis a quality assurance program which involves the assessment of all quality assurance activities conducted in the provision of its health care services to its subscribers, which shall include no less than:(1) Assessment of health outcomes;(2) Ongoing review of health services by physicians and other health professionals; and(3) Utilization and systematic data collection.(d) Every health maintenance organization and provider shall submit its books and records to those examinations and in every way facilitate them. For the purpose of examinations, the director of business regulation and the director of health may administer oaths to, and examine, the officers and agents of the health maintenance organization and the principals of their providers concerning their business.(e) The expenses of examinations under this section shall be assessed against the organization being examined and remitted to the director of the department for whom the examination is being conducted. The total cost of those examinations, whether made by the director of business regulation or by the director of health, shall be borne by the examined health maintenance organizations and shall be in the same amount as provided for in § 27-13-1, and shall be paid to the director of the department conducting the examination for deposit as general revenues. That assessment shall be in addition to any taxes and fees payable to the state. In instances where the examination is performed by outside accountants, the expenses of the examination shall be borne by the examined health maintenance organization.(f) In lieu of any state examination, the director of business regulation or the director of health may accept the report of an examination made by the director of business regulation or the director of health of another state.History of Section.P.L. 1983, ch. 225, § 2; P.L. 1992, ch. 133, art. 24, § 1; P.L. 1994, ch. 404, § 13; P.L. 1995, ch. 370, art. 40, § 88.
RI Gen L § 27-41-18 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-41 - Health Maintenance Organizations|Section 27-41-18 - Rehabilitation, liquidation, or conservation of health maintenance organization.

§ 27-41-18. Rehabilitation, liquidation, or conservation of health maintenance organization.(a) Any rehabilitation, liquidation, or conservation of a health maintenance organization shall be deemed to be the rehabilitation, liquidation, or conservation of an insurance company and shall be conducted under the supervision of the director of business regulation pursuant to chapters 14.1, 14.2, and 14.3 of this title. The director of business regulation may apply for an order from the superior court directing the director to rehabilitate, liquidate, or conserve a health maintenance organization upon any one or more of the grounds included in chapter 14.3 of this title or upon any one or more of the following grounds:(1) That the health maintenance organization is insolvent;(2) That the health maintenance organization is in an unsound financial condition;(3) That the health maintenance organization's business policies are unsound or improper;(4) That the health maintenance organization's condition or management is such as to render its further transaction of business hazardous to the public or its enrollees;(5) That the health maintenance organization's funds, net cash, or contingent assets are deficient; or(6) That the health maintenance organization is conducting its business fraudulently or refuses or neglects to comply with the laws of this state.(b) A claim by a health care provider who agrees not to assert that claim against any enrollee of the health maintenance organization for an uncovered expenditure has priority over other providers of services.(c) For purposes of determining the priority of distribution of general assets, claims of enrollees and enrollees' beneficiaries shall have the same priority as established in chapter 14.3 of this title for policyholders and beneficiaries of insureds of insurance companies. If an enrollee is liable to a provider for services provided pursuant to and covered by the health benefit plan, that liability shall have the status of an enrollee claim for distribution of general assets. A provider who is obligated by statute or agreement to hold enrollees harmless from liability for services provided pursuant to and covered by a health benefit plan shall have a priority of distribution of the general assets immediately following that of enrollees and enrollees' beneficiaries as described herein, and immediately preceding the priority of distribution for priority Class 7 described in § 27-14.3-46.History of Section.P.L. 1983, ch. 225, § 2; P.L. 1991, ch. 370, § 4; P.L. 2005, ch. 176, § 1.
RI Gen L § 27-41-18.1 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-41 - Health Maintenance Organizations|Section 27-41-18.1 - Summary orders and supervision.

§ 27-41-18.1. Summary orders and supervision.(a) Whenever the director determines that the financial condition of a health maintenance organization is such that its continued operation must be hazardous to its enrollees, creditors, or the general public, or that it has violated any provision of this act, the director may, after notice and hearing, order the health maintenance organization to take action reasonably necessary to rectify the condition or violation, including, but not limited to, one or more of the following:(1) Reduce the total amount of present and potential liability for benefits by reinsurance or other method acceptable to the director;(2) Reduce the volume of new business being accepted;(3) Reduce expenses by specified methods;(4) Suspend or limit the writing of new business for a period of time;(5) Increase the health maintenance organization's capital and surplus by contribution;(6) Initiate administrative supervision proceedings against the health maintenance organization in accordance with chapter 14.1 of this title; or(7) Take other steps the director may deem appropriate under the circumstances.(b) For purposes of this section, the violation by a health maintenance organization of any law of this state to which the health maintenance organization is subject shall be deemed a violation of this act.(c) The director is authorized to adopt regulations to set uniform standards and criteria for early warning that the continued operation of any health maintenance organization might be hazardous to its enrollees, creditors, or the general public and to set standards for evaluating the financial condition of any health maintenance organization.(d) The remedies and measures available to the director under this section shall be in addition to, and not in lieu of, the remedies and measures available to the director under the provisions of chapters 14.1, 14.2 and 14.3 of this title.History of Section.P.L. 2005, ch. 176, § 2.
RI Gen L § 27-41-19 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-41 - Health Maintenance Organizations|Section 27-41-19 - Rules and regulations.

§ 27-41-19. Rules and regulations.The director of business regulation and the director of health shall, after notice and hearing, promulgate reasonable rules and regulations that are necessary or proper to carry out the provisions of this chapter. Those rules and regulations shall be subject to review in accordance with the provisions of chapter 35 of title 42.History of Section.P.L. 1983, ch. 225, § 2; P.L. 1995, ch. 334, § 1; P.L. 2002, ch. 292, § 85.
RI Gen L § 27-41-20 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-41 - Health Maintenance Organizations|Section 27-41-20 - Administrative procedures.

§ 27-41-20. Administrative procedures.(a) When the director of business regulation has cause to believe that grounds for the denial of an application for a license exist, or that grounds for the suspension or revocation of a license exist, the director shall notify the health maintenance organization and the director of health, in writing, specifically stating the grounds for denial, suspension, or revocation and fixing a time for a hearing on the matter.(b) The director of health, or his or her designated representative, shall be in attendance at the hearing and shall participate in the proceedings. The recommendation and findings of the director of health, with respect to matters relating to the quality of health care services provided by the health maintenance organization in connection with any decision regarding the denial, suspension, or revocation of a license, shall be conclusive and binding upon the director of business regulation. After the hearing, or upon the failure of the health maintenance organization to appear at the hearing, the director of business regulation shall take any action that is deemed advisable on written findings that shall be mailed to the health maintenance organization with a copy to the director of health. The action of the director of business regulation and the recommendation and findings of the director of health shall be subject to review by the superior court for the county of Providence.(c) The provisions of chapter 35 of title 42 shall apply to proceedings under this section to the extent they are not in conflict with subsections (a) and (b) of this section.History of Section.P.L. 1983, ch. 225, § 2.
RI Gen L § 27-41-22 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-41 - Health Maintenance Organizations|Section 27-41-22 - Statutory construction and relationship to other laws.

§ 27-41-22. Statutory construction and relationship to other laws.(a) Except as otherwise provided in this chapter provisions of chapters 19, 20, 20.1, and 20.2 of this title shall not be applicable to any health maintenance organization granted a license under this chapter. This provision shall not apply to an insurer or hospital or medical service corporation licensed and regulated pursuant to the insurance laws or the hospital or medical service corporation laws of this state except with respect to its health maintenance organization activities authorized and regulated pursuant to this chapter.(b) Solicitation of enrollees by a health maintenance organization granted a license, or its representatives, shall not be construed to violate any provision of law relating to solicitation or advertising by health professionals.(c) Any health maintenance organization authorized under this chapter shall not be deemed to be practicing a profession, and may employ, or contract with, any licensed health professional to deliver professional services.(d) No section of chapter 15 of title 23, the Health Care Certificate of Need Act, shall be abridged by this chapter.(e) All information relating to a subscriber's health care history, diagnosis, condition, treatment, or evaluation shall be considered confidential health care information and shall not be released or transferred except under the safeguards established by chapter 37.3 of title 5, the Confidentiality of Health Care Information Act.(f) The provisions of chapter 19.1 of this title, relating to extended medical benefits, shall be construed to apply to enrollees of health maintenance organizations.(g) Any health maintenance organization authorized under this chapter shall be deemed to be an insurer, for the purposes of compliance with chapter 44-17.History of Section.P.L. 1983, ch. 225, § 2; P.L. 2007, ch. 73, art. 28, § 3.
RI Gen L § 27-41-23 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-41 - Health Maintenance Organizations|Section 27-41-23 - Filings and reports as public documents.

§ 27-41-23. Filings and reports as public documents.The provisions of chapter 2 of title 38, relating to access to public records, shall apply to all applications, filings, and reports required under this chapter. Annual and quarterly financial statements shall be treated as public documents.History of Section.P.L. 1983, ch. 225, § 2; P.L. 1994, ch. 404, § 13.
RI Gen L § 27-41-24 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-41 - Health Maintenance Organizations|Section 27-41-24 - Director of health's authority to contract.

§ 27-41-24. Director of health's authority to contract.The director of health, in carrying out his or her obligations under §§ 27-41-4(a)(2), 27-41-16(b), and 27-41-17(b), may contract with qualified persons to make recommendations concerning the determinations required to be made by the director. Those recommendations may be accepted in full or in part by the director of health.History of Section.P.L. 1983, ch. 225, § 2.
RI Gen L § 27-41-25 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-41 - Health Maintenance Organizations|Section 27-41-25 - Holding company systems.

§ 27-41-25. Holding company systems.Except to the extent superseded by chapter 64 of this title, all of the provisions of chapter 35 of this title apply to corporations organized or licensed pursuant to this chapter.History of Section.P.L. 1983, ch. 225, § 2; P.L. 1998, ch. 90, § 5; P.L. 2000, ch. 178, § 9; P.L. 2000, ch. 200, § 19; P.L. 2000, ch. 229, § 19.
RI Gen L § 27-41-26 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-41 - Health Maintenance Organizations|Section 27-41-26 - Enrollee liability.

§ 27-41-26. Enrollee liability.No enrollee is liable to any provider for charges for covered health services, except for amounts due for copayments, when provided or made available to enrolled participants by a licensed health maintenance organization during a period in which premiums were paid by or on behalf of the enrollee.History of Section.P.L. 1983, ch. 225, § 2; P.L. 2003, ch. 341, § 1.
RI Gen L § 27-41-26.1 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-41 - Health Maintenance Organizations|Section 27-41-26.1 - Patient responsibility - Administrative requirements.

§ 27-41-26.1. Patient responsibility — Administrative requirements.For health benefit contracts issued, renewed, or delivered in this state the following shall apply:(1) The amount of copayments for physician office visits and hospital emergency room visits shall be printed on the subscriber identification cards issued to the insured.(2) A schedule of all applicable copayments, by product or by group, in paper or electronic format, or both, shall be published, updated, and distributed to participating providers.(3) On an annual basis, notification shall be provided to subscribers regarding their responsibility for copayments and deductibles.History of Section.P.L. 2001, ch. 283, § 3; P.L. 2002, ch. 292, § 85.
RI Gen L § 27-41-27.1 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-41 - Health Maintenance Organizations|Section 27-41-27.1 - No derogation of attorney general.

§ 27-41-27.1. No derogation of attorney general.No provision of this chapter shall derogate from the common law or statutory authority of the attorney general nor shall any provision be construed as a limitation on the common law or statutory authority of the attorney general, including the authority to investigate at any time charitable assets for the purpose of determining and ascertaining whether they are being administered in accordance with law and with the terms and purposes of the law.History of Section.P.L. 1998, ch. 90, § 10.
RI Gen L § 27-41-27.2 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-41 - Health Maintenance Organizations|Section 27-41-27.2 - Health insurance rates.

§ 27-41-27.2. 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 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: (1) may file with any state agency for review or approval any proposed rate to be used by the company in the state, or (2) may 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 this 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, § 5; P.L. 1999, ch. 376, § 5.