reglab/housing_qa huggingface dataset:
RI Gen L § 27-18.9-5 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-18.9 - Benefit Determination and Utilization Review Act|Section 27-18.9-5 - Administrative and non-administrative benefit determination procedural requirements.

§ 27-18.9-5. Administrative and non-administrative benefit determination procedural requirements.(a) (1) Procedural failure by claimant. In the event of the failure of claimant or an authorized representative to follow the healthcare entities claims procedures for a pre-service claim the healthcare entity or its review agent must:(i) Notify claimant or the authorized representative, as appropriate, of this failure as soon as possible and no later than five (5) calendar days following the failure and this notification must also inform claimant of the proper procedures to file a pre-service claim; and(ii) Notwithstanding the above, if the pre-service claim relates to urgent or emergent healthcare services, the healthcare entity or its review agent must notify and inform claimant or the authorized representative, as appropriate, of the failure and proper procedures within twenty-four (24) hours following the failure. Notification may be oral, unless written notification is requested by the claimant or authorized representative.(2) Claimant must have stated name, specific medical condition or symptom and specific treatment, service, or product for which approval is requested and submitted to proper claim processing unit.(b) (1) Utilization review agent procedural requirements: All initial, prospective, and concurrent non-administrative, adverse benefit determinations of a healthcare service that had been ordered by a physician, dentist, or other practitioner shall be made, documented, and signed by a licensed practitioner with the same licensure status as the ordering provider;(2) Utilization review agents are not prohibited from allowing appropriately qualified review agency staff from engaging in discussions with the attending provider, the attending provider's designee or appropriate healthcare facility and office personnel regarding alternative service and/or treatment options. Such a discussion shall not constitute an adverse benefit determination; provided, however, that any change to the attending provider's original order and/or any decision for an alternative level of care must be made and/or appropriately consented to by the attending provider or the provider's designee responsible for treating the beneficiary and must be documented by the review agent; and(3) A utilization review agent shall not retrospectively deny authorization for healthcare services provided to a covered person when an authorization has been obtained for that service from the review agent unless the approval was based upon inaccurate information material to the review or the healthcare services were not provided consistent with the provider's submitted plan of care and/or any restrictions included in the prior approval granted by the review agent.History of Section.P.L. 2017, ch. 302, art. 5, § 5.
RI Gen L § 27-18.9-9 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-18.9 - Benefit Determination and Utilization Review Act|Section 27-18.9-9 - Reporting requirements.

§ 27-18.9-9. Reporting requirements.The office shall establish reporting requirements to determine if adverse benefit determination and/or utilization review programs are in compliance with the provisions of this chapter and applicable regulations as well as in compliance with applicable federal law.History of Section.P.L. 2017, ch. 302, art. 5, § 5.
RI Gen L § 27-18.9-10 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-18.9 - Benefit Determination and Utilization Review Act|Section 27-18.9-10 - Rules and regulations.

§ 27-18.9-10. Rules and regulations.The health insurance commissioner may promulgate such rules and regulations as are necessary and proper to effectuate the purpose and for the efficient administration and enforcement of this chapter.History of Section.P.L. 2017, ch. 302, art. 5, § 5.
RI Gen L § 27-18.9-11 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-18.9 - Benefit Determination and Utilization Review Act|Section 27-18.9-11 - Waiver of requirements.

§ 27-18.9-11. Waiver of requirements.(a) The office shall waive the requirements of this chapter only when a conflict exists with those activities of a review agent that are conducted pursuant to contracts with the state or the federal government or those activities under other state or federal jurisdictions.(b) The office shall waive de minimus activity, in accordance with the regulations adopted by the commissioner.History of Section.P.L. 2017, ch. 302, art. 5, § 5.
RI Gen L § 27-18.9-12 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-18.9 - Benefit Determination and Utilization Review Act|Section 27-18.9-12 - Variance of statutory requirements.

§ 27-18.9-12. Variance of statutory requirements.Statutory variances shall be issued for a period not to exceed one year and may be subject to such terms and conditions deemed necessary as determined by the commissioner. Prior to issuing a statutory variance, the office may provide notice and public hearing to ensure necessary beneficiary and healthcare provider protections in the process.History of Section.P.L. 2017, ch. 302, art. 5, § 5.
RI Gen L § 27-18.9-13 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-18.9 - Benefit Determination and Utilization Review Act|Section 27-18.9-13 - Denial, suspension, or revocation of certificate - Penalties.

§ 27-18.9-13. Denial, suspension, or revocation of certificate — Penalties.Adopted pursuant to this chapter;(a) The office may deny a certificate or certification upon review of the application if, upon review of the application, it finds that the applicant proposing to conduct utilization review does not meet the standards required by this chapter or by any regulations promulgated pursuant to this chapter.(b) The office may revoke or suspend a certificate or certification and/or impose monetary penalties not less than one hundred dollars ($100) and not to exceed fifty thousand dollars ($50,000) per violation and/or impose an order requiring a monetary restitution or disgorgement payment in an amount determined by the commissioner to reasonably reflect the amount of damages caused or monies improperly obtained in any case in which:(1) The healthcare entity and/or review agent fails to comply with the requirements of this chapter or of regulations;(2) The review agent/network plan and/or healthcare entity and/or review agent fails to comply with the criteria used by it in its application for a certificate or certification; or(3) The healthcare entity and/or review agent refuses to permit or fails to reasonably cooperate with an examination by the commissioner to determine compliance with the requirements of this chapter and regulations promulgated pursuant to the authority granted to the commissioner in this chapter. These determinations may involve consideration of any written grievances filed with the office against the healthcare entity and/or review agent by patients or providers.(c) Any applicant or certificate or certification holder aggrieved by an order or a decision of the commissioner made under this chapter without a hearing may, within thirty (30) days after notice of the order or decision, make a written request to the office for a hearing on the order or decision pursuant to § 42-35-15.(d) The procedure governing hearings authorized by this section shall be in accordance with §§ 42-35-9 through 42-35-13 as stipulated in § 42-35-14(a). A full and complete record shall be kept of all proceedings, and all testimony shall be recorded but need not be transcribed unless the decision is appealed pursuant to § 42-35-15. A copy or copies of the transcript may be obtained by any interested party upon payment of the cost of preparing the copy or copies. Witnesses may be subpoenaed by either party.History of Section.P.L. 2017, ch. 302, art. 5, § 5.
RI Gen L § 27-18.9-14 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-18.9 - Benefit Determination and Utilization Review Act|Section 27-18.9-14 - Penalties and enforcement.

§ 27-18.9-14. Penalties and enforcement.For the purposes of this chapter, in addition to the provisions of § 27-18.9-13, a healthcare entity and/or review agent or any person or entity conducting any activities requiring certification under this chapter shall be subject to the penalty and enforcement provisions of title 27 and chapters 14 and 14.5 of title 42 and the regulations promulgated thereunder in the same manner as a licensee or any person or entity conducting any activities requiring licensure or certification under title 27.History of Section.P.L. 2017, ch. 302, art. 5, § 5.
RI Gen L § 27-18.9-15 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-18.9 - Benefit Determination and Utilization Review Act|Section 27-18.9-15 - Severability.

§ 27-18.9-15. Severability.If any provision of this chapter or the application of any provision to any person or circumstance shall be held invalid, that invalidity shall not affect the provisions or application of this chapter which can be given effect without the invalid provision or application, and to this end the provisions of this chapter are declared to be severable.History of Section.P.L. 2017, ch. 302, art. 5, § 5.
RI Gen L § 27-19-2 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-19 - Nonprofit Hospital Service Corporations|Section 27-19-2 - Organization as charitable corporation - Insurance laws inapplicable.

§ 27-19-2. Organization as charitable corporation — Insurance laws inapplicable.Each nonprofit hospital service corporation shall be incorporated as a charitable corporation under the provisions of chapter 6 of title 7, and shall be subject to that chapter and to this chapter. The laws of this state relative to insurance companies or to the business insurance shall not apply to any nonprofit hospital service corporation unless expressly provided in those laws. Each nonprofit hospital service corporation shall be deemed to be an insurer, for the purposes of compliance with chapter 44-17.History of Section.P.L. 1939, ch. 719, § 2; G.L. 1956, § 27-19-2; P.L. 2007, ch. 73, art. 28, § 1.
RI Gen L § 27-19-2.1 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-19 - Nonprofit Hospital Service Corporations|Section 27-19-2.1 - Investments and holdings in certain corporations authorized.

§ 27-19-2.1. Investments and holdings in certain corporations authorized.(a) Each nonprofit hospital service corporation shall have, in addition to all other powers granted under this chapter and the laws of this state, the power to invest in or cause to be organized and established one or more corporations, all or any portion of the issued and outstanding capital stock of which shall be subscribed for or held by the nonprofit hospital service corporation.(b) As used in this section, "corporation" means any organization incorporated under the provisions of the law of this or another state for one or more of the following purposes:(1) To establish, maintain, and operate hospital service and health insurance plans;(2) To develop, establish, purchase, maintain, perform, sell, and lease in connection with carrying out its corporate purpose: (i) data processing and computer software programs, systems, and techniques; (ii) data processing, bookkeeping, statistical, or software services; or (iii) other administrative and related services; or(3) To exercise the powers set forth in § 27-19-5 or to carry out and fulfill any of the purposes of a hospital service corporation incorporated under this chapter.(c) Any limitation on investments or holdings contained in § 27-19-11 or § 27-19-5.3 or any other law shall not apply with respect to investments or holdings under this section; provided, that the value of any investment shall not exceed twenty percent (20%) of the assets of the hospital service corporation.History of Section.P.L. 1982, ch. 165, § 1; P.L. 2006, ch. 182, § 1; P.L. 2006, ch. 600, § 1.
RI Gen L § 27-19-3 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-19 - Nonprofit Hospital Service Corporations|Section 27-19-3 - Repealed.

§ 27-19-3. Repealed.
RI Gen L § 27-19-4 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-19 - Nonprofit Hospital Service Corporations|Section 27-19-4 - Certificate of public convenience and advantage.

§ 27-19-4. Certificate of public convenience and advantage.No articles of association of a nonprofit hospital service corporation shall be filed in the office of the secretary of state unless and until the insurance commissioner has certified in writing upon those articles that he or she has determined that public convenience and advantage will be promoted by the establishment of the corporation.History of Section.P.L. 1939, ch. 719, § 2; G.L. 1956, § 27-19-4.
RI Gen L § 27-19-5.1 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-19 - Nonprofit Hospital Service Corporations|Section 27-19-5.1 - Cancellation of coverage by employers.

§ 27-19-5.1. Cancellation of coverage by employers.No employer shall cancel any contract of insurance provided for the benefit of his or her employee as provided for in this chapter without first allowing the employee the opportunity to continue the contract of insurance, with the employee paying an amount not to exceed the total contribution required of the employer and employee for the continuation of the protection while the employee is disabled and receiving benefits pursuant to the provision of the Workers' Compensation Act, chapters 29 — 38 of title 28.History of Section.P.L. 1971, ch. 228, § 1.
RI Gen L § 27-19-5.2 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-19 - Nonprofit Hospital Service Corporations|Section 27-19-5.2 - Patient responsibility - Administrative requirements.

§ 27-19-5.2. Patient responsibility — Administrative requirements.For health benefit contracts issued, renewed, or delivered on or after April 1, 2002, 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 insureds.(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) Notification shall be provided to subscribers on an annual basis regarding their responsibility for copayments and deductibles.History of Section.P.L. 2001, ch. 283, § 1.
RI Gen L § 27-19-5.3 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-19 - Nonprofit Hospital Service Corporations|Section 27-19-5.3 - Additional powers.

§ 27-19-5.3. Additional powers.Notwithstanding any other law or section of this chapter which may be inconsistent with this section, each nonprofit hospital service corporation may, through a subsidiary, develop, underwrite and/or offer for sale life insurance, disability insurance, long-term care insurance, employee assistance programs and/or other health related programs; provided, however, prior to underwriting risk under policies of insurance listed above, the nonprofit hospital service corporation must first demonstrate that underwriting such risk is consistent with the statutory mission of the nonprofit hospital service corporation and obtain prior written approval from the health insurance commissioner. Each nonprofit hospital service corporation may also directly, or by contracting with another entity, develop and/or offer for sale the policies or programs described in this section. However, the nonprofit hospital service corporation shall not directly underwrite any risk under a policy of insurance described in this section.History of Section.P.L. 2006, ch. 182, § 2; P.L. 2006, ch. 600, § 2.
RI Gen L § 27-19-7 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-19 - Nonprofit Hospital Service Corporations|Section 27-19-7 - Rates charged by hospitals.

§ 27-19-7. Rates charged by hospitals.(a) The rates charged by contracting hospitals to any nonprofit hospital service corporation for hospital services rendered by the hospitals to the subscribers of the corporation shall be established from time to time by agreement between the contracting hospitals and the corporation.(b) Upon completion of its services, each contracting hospital shall, upon request, provide a copy of an itemized bill for each patient; provided, that nothing contained in this subsection shall be construed to apply to any hospital operated by the state of Rhode Island, its departments, or agencies.History of Section.P.L. 1939, ch. 719, § 3; G.L. 1956, § 27-19-7; P.L. 1985, ch. 529, § 1.
RI Gen L § 27-19-7.1 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-19 - Nonprofit Hospital Service Corporations|Section 27-19-7.1 - Uniform explanation of benefits and coverage.

§ 27-19-7.1. Uniform explanation of benefits and coverage.(a) A nonprofit hospital service corporation shall provide a summary of benefits and coverage explanation and definitions to policyholders and others required by, and at the times and in the format required, by the federal regulations adopted under section 2715 of the Public Health Service Act, as amended by the federal Affordable Care Act [42 U.S.C. § 300gg-15]. The forms required by this section shall be made available to the commissioner on request. Nothing in this section shall be construed to limit the authority of the commissioner under existing state law.(b) The provisions of this section shall apply to grandfathered health plans. 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.(c) If the commissioner of the office of the health insurance commissioner determines that the corresponding provision of the federal Patient Protection and Affordable Care Act has been declared invalid by a final judgment of the federal judicial branch or has been repealed by an act of Congress, on the date of the commissioner's determination this section shall have its effectiveness suspended indefinitely, and the commissioner shall take no action to enforce this section. Nothing in this section shall be construed to limit the authority of the commissioner under existing state law.History of Section.P.L. 2012, ch. 256, § 6; P.L. 2012, ch. 262, § 6.
RI Gen L § 27-19-7.2 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-19 - Nonprofit Hospital Service Corporations|Section 27-19-7.2 - Filing of policy forms.

§ 27-19-7.2. Filing of policy forms.(a) A nonprofit hospital service corporation shall file all policy forms and rates used by it in the state with the commissioner, including the forms of any rider, endorsement, application blank, and other matter generally used or incorporated by reference in its policies or contracts of insurance. No such form shall be used if disapproved by the commissioner under this section, or if the commissioner's approval has been withdrawn after notice and an opportunity to be heard, or until the expiration of sixty (60) days following the filing of the form. Such a company shall comply with its filed and approved forms. If the commissioner finds from an examination of any form that it is contrary to the public interest, or the requirements of this code or duly promulgated regulations, he or she shall forbid its use, and shall notify the corporation in writing.(b) Each rate filing shall include a certification by a qualified actuary that to the best of the actuary's knowledge and judgment, the entire rate filing is in compliance with applicable laws and that the benefits offered or proposed to be offered are reasonable in relation to the premium to be charged. A health insurance carrier shall comply with its filed and approved rates and forms.History of Section.P.L. 2012, ch. 256, § 6; P.L. 2012, ch. 262, § 6.
RI Gen L § 27-19-8 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-19 - Nonprofit Hospital Service Corporations|Section 27-19-8 - Annual and quarterly statements.

§ 27-19-8. Annual and quarterly statements.(a) Every nonprofit hospital service corporation shall annually, on or before the first day of March in each year, file in the office of the commissioner of insurance a statement, verified by at least two (2) of the principal officers of the corporation, of its condition on the thirty-first day of December then next preceding, which statement shall be in general form and context as approved by the National Association of Insurance Commissioners and contain any matters the commissioner shall prescribe and shall be available for inspection by the public.(b) Every nonprofit hospital service corporation shall also file quarterly statements with the insurance commissioner, due on or before forty-five (45) days after the quarter ending in accordance with the National Association of Insurance Commissioners' guidelines and procedures, and shall be available for inspection by the public.(c) The insurance commissioner shall also require compliance with chapters 12 and 12.1 of this title.History of Section.P.L. 1939, ch. 719, § 4; G.L. 1956, § 27-19-8; P.L. 1994, ch. 404, § 1; P.L. 1996, ch. 188, § 9.
RI Gen L § 27-19-9 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-19 - Nonprofit Hospital Service Corporations|Section 27-19-9 - Examination of affairs of corporations.

§ 27-19-9. Examination of affairs of corporations.It is the duty of the insurance commissioner to make an examination of the financial condition and methods of doing business of every nonprofit hospital service corporation. The examination shall be performed, and the associated costs borne by the company, in accordance with all of the provisions of chapter 13.1 of this title.History of Section.P.L. 1939, ch. 719, § 5; G.L. 1956, § 27-19-9; P.L. 1960, ch. 71, art. 1, § 10; P.L. 1967, ch. 154, § 1; P.L. 1994, ch. 404, § 1; P.L. 2002, ch. 292, § 37.
RI Gen L § 27-19-10 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-19 - Nonprofit Hospital Service Corporations|Section 27-19-10 - Commission plans for solicitors or insurance producers.

§ 27-19-10. Commission plans for solicitors or insurance producers.No person shall be engaged to solicit subscribers to any nonprofit hospital service plan upon a commission basis or upon any other basis by which the payment of the compensation or expenses of that person shall be conditioned upon the enrollment of subscribers, unless the method of solicitation and rate of compensation shall have had the prior written approval of the insurance commissioner.History of Section.P.L. 1939, ch. 719, § 6; G.L. 1956, § 27-19-10.