reglab/housing_qa huggingface dataset:
RI Gen L § 27-41-28 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-41 - Health Maintenance Organizations|Section 27-41-28 - Applicability.

§ 27-41-28. Applicability.Notwithstanding any of the provisions of this chapter, except for §§ 27-41-5, 27-41-26, 27-41-35, and 27-41-37 which shall apply to all licensed health maintenance organizations including health maintenance organizations licensed pursuant to chapter 17 of title 23, nothing contained in this chapter shall apply to those health maintenance organizations licensed pursuant to chapter 17 of title 23 which were actively engaged in the provision of or making available to enrolled participants health care services prior to January 1, 1982; provided, that this exemption shall not under any circumstances have effect beyond July 1, 1994, and that on and after July 1, 1991, § 27-41-18 shall also apply to all licensed health maintenance organizations licensed pursuant to chapter 17 of title 23. Any health maintenance organization which was actively engaged in the provision of or making available to enrolled participants health care services prior to January 1, 1982, including a health maintenance organization which experiences a "change in owner" or "change in operator" as defined in § 23-17-2(5) and (4), respectively, may, at its discretion, continue to be licensed under the requirements and provisions of chapter 17 of title 23 until July 1, 1994, or under the requirements and provisions of this chapter. That health maintenance organization shall be deemed to be licensed under the requirements and the provisions of this chapter upon submission of materials required under § 27-41-3(b)(1), (2), (3), (4) and (11) sufficient and satisfactory to the director. Until July 1, 1998, the directors shall waive, reduce, or alter the requirements of §§ 27-41-4 and 27-41-13 for licensure for this defined class of health maintenance organizations unless after notice and hearing he or she finds that reasonable progress is not being made toward meeting the requirements of those sections. After July 1, 1998 the director may waive, reduce, or alter the requirements of §§ 27-41-4 and 27-41-13 for licensure for this defined class of health maintenance organizations if the licensee demonstrates to the satisfaction of the director that it is making satisfactory progress toward compliance with the requirements of those sections.History of Section.P.L. 1983, ch. 225, § 2; P.L. 1990, ch. 161, § 1; P.L. 1991, ch. 345, § 5; P.L. 1991, ch. 370, § 4.
RI Gen L § 27-41-29 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-41 - Health Maintenance Organizations|Section 27-41-29 - Severability.

§ 27-41-29. Severability.If any section, term, or provision of this chapter shall be adjudged invalid for any reason, that judgment shall not affect, impair, or invalidate any other section, term, or provision of this chapter, but the remaining sections, terms, and provisions shall be and remain in full force and effect.History of Section.P.L. 1983, ch. 225, § 2.
RI Gen L § 27-41-29.1 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-41 - Health Maintenance Organizations|Section 27-41-29.1 - Uniform explanation of benefits and coverage.

§ 27-41-29.1. Uniform explanation of benefits and coverage.(a) A health maintenance organization 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, § 10; P.L. 2012, ch. 262, § 10.
RI Gen L § 27-41-29.2 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-41 - Health Maintenance Organizations|Section 27-41-29.2 - Filing of policy forms.

§ 27-41-29.2. Filing of policy forms.(a) A health maintenance organization 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, § 10; P.L. 2012, ch. 262, § 10.
RI Gen L § 27-41-30 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-41 - Health Maintenance Organizations|Section 27-41-30 - Mammograms and pap smears - Coverage mandated.

§ 27-41-30. Mammograms and pap smears — Coverage mandated.(a) Subscribers to any health maintenance organization plan shall be afforded coverage under that plan for mammograms and pap smears, in accordance with guidelines established by the American Cancer Society.(b) Notwithstanding the provisions of this chapter, subscribers to any health maintenance organization plan shall be afforded coverage for two (2) paid screening mammograms per year when recommended by a physician for women who have been treated for breast cancer within the last five (5) years or who are at high risk of developing breast cancer due to genetic predisposition (BRCA gene mutation or multiple first degree relatives) or high risk lesion on prior biopsy (lobular carcinoma in situ) or atypical ductal hyperplasia.History of Section.P.L. 1988, ch. 532, § 3; P.L. 2005, ch. 405, § 4.
RI Gen L § 27-41-30.1 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-41 - Health Maintenance Organizations|Section 27-41-30.1 - Post-partum hospital stays.

§ 27-41-30.1. Post-partum hospital stays.(a) Every individual or group hospital or medical services plan contract delivered, issued for delivery, or renewed in this state shall provide coverage for a forty-eight (48) hour time period in a hospital after a vaginal birth, and ninety-six (96) hours after a Cesarean section for a mother and her newly born child. Any decision to shorten these minimum coverages shall be made by the attending health care provider in consultation with the mother. The decision shall be made in accordance with the standards for guidelines for perinatal care published by the American College of Obstetrics and Gynecology and the American Academy of Pediatrics. The standards shall be relative to early discharge, defined as less than forty-eight (48) hours for a vaginal delivery and ninety-six (96) for a Cesarean delivery. In the case of early discharge, post-delivery care shall include home visits, parent education, assistance and training in breast or bottle feeding and the performance of any necessary and appropriate clinical tests or any other tests or services consistent with the guidelines in this subsection.(b) For the purposes of this section, "attending health care provider" includes the attending obstetrician, pediatrician, family practitioner, general practitioner or certified nurse midwife attending the mother and newly born child.(c) Any member who is aggrieved by a denial of benefits to be provided under this section may appeal the denial in accordance with regulations of the department of health, which have been promulgated pursuant to chapter 17.12 of title 23. No policy or plan covered under this chapter shall terminate the services, reduce capitation payment, or penalize an attending physician or other health care provider who orders care consistent with the provisions of this section.History of Section.P.L. 1996, ch. 246, § 5; P.L. 1996, ch. 260, § 5; P.L. 2002, ch. 292, § 85.
RI Gen L § 27-41-31 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-41 - Health Maintenance Organizations|Section 27-41-31 - Mammograms - Quality assurance standards.

§ 27-41-31. Mammograms — Quality assurance standards.A mammogram eligible for reimbursement under § 27-41-30 shall be reimbursed only if the facility in which the mammogram has been taken and processed, and the licensed physician interpreting the mammogram both meet state approved quality assurance standards for taking, processing, and interpreting mammograms. The director of health shall have the authority to promulgate rules and regulations necessary to carry out the provisions of this section.History of Section.P.L. 1989, ch. 217, § 4.
RI Gen L § 27-41-32 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-41 - Health Maintenance Organizations|Section 27-41-32 - Pap smears - Quality assurance standards.

§ 27-41-32. Pap smears — Quality assurance standards.A pap smear eligible for reimbursement under § 27-41-30 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 of health care organizations or the American Osteopathic Association at the time the pap smear is processed.History of Section.P.L. 1989, ch. 217, § 11.
RI Gen L § 27-41-33 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-41 - Health Maintenance Organizations|Section 27-41-33 - Coverage for infertility.

§ 27-41-33. Coverage for infertility.(a) Any health maintenance organization service contract plan or policy delivered, issued for delivery, or renewed in this state, except a contract providing supplemental coverage to Medicare or other governmental programs, that includes pregnancy-related benefits, shall provide coverage for medically necessary expenses of diagnosis and treatment of infertility for women between the ages of twenty-five (25) and forty-two (42) years and for standard fertility-preservation services when a medically necessary medical treatment may directly or indirectly cause iatrogenic infertility to a covered person. To the extent that a health maintenance organization provides reimbursement for a test or procedure used in the diagnosis or treatment of conditions other than infertility, those tests and procedures shall not be excluded from reimbursement when provided attendant to the diagnosis and treatment of infertility for women between the ages of twenty-five (25) and forty-two (42) years; provided, that subscriber copayment, not to exceed twenty percent (20%), may be required for those programs and/or procedures the sole purpose of which is the treatment of infertility.(b) For purposes of this section, "infertility" means the condition of an otherwise healthy individual who is unable to conceive or sustain a pregnancy during a period of one year.(c) For purposes of this section, "standard fertility-preservation services" means procedures consistent with established medical practices and professional guidelines published by the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or other reputable professional medical organizations.(d) For purposes of this section, "iatrogenic infertility" means an impairment of fertility by surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or processes.(e) For purposes of this section, "may directly or indirectly cause" means treatment with a likely side effect of infertility as established by the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or other reputable professional organizations.(f) The health insurance contract may limit coverage to a lifetime cap of one hundred thousand dollars ($100,000).History of Section.P.L. 1989, ch. 478, § 4; P.L. 2002, ch. 292, § 85; P.L. 2006, ch. 246, art. 34, § 4; P.L. 2007, ch. 411, § 4; P.L. 2017, ch. 132, § 4; P.L. 2017, ch. 150, § 4.
RI Gen L § 27-41-34 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-41 - Health Maintenance Organizations|Section 27-41-34 - Health maintenance organizations' assessment.

§ 27-41-34. Health maintenance organizations' assessment.(a) Notwithstanding any other provisions of law, each domestic HMO shall be charged an assessment to partially support the activities of the division of insurance in the department of business regulation.(b) Each domestic HMO assessment shall be determined in accordance with the following ratio: (1) by dividing the HMO total direct premiums by the total direct premiums, including annuities, less policyholder dividends of all domestic insurance companies plus the total direct premiums of domestic companies licensed or regulated pursuant to chapters 19, 20, 20.1, 20.2, 20.3, 25, and 41 of this title, and chapter 62 of title 42; (2) and then by multiplying the resulting ratio times two hundred thousand dollars ($200,000).(c) The minimum assessment charged shall be the greater of the sum determined by subsection (b) of this section or one thousand dollars ($1,000).History of Section.P.L. 1990, ch. 65, art. 29, § 8; P.L. 2002, ch. 292, § 85.
RI Gen L § 27-41-36 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-41 - Health Maintenance Organizations|Section 27-41-36 - Services of midwives.

§ 27-41-36. Services of midwives.Every health maintenance organization plan contract delivered, issued for delivery, or renewed in this state shall provide coverage for the services of licensed midwives in accordance with each health maintenance organization's respective principles and mechanisms of reimbursement, credentialing, and contracting if the services are within the licensed midwives' area of professional competence as defined by regulations promulgated pursuant to § 23-13-9 and are currently reimbursed when rendered by any other licensed health care provider. No health maintenance organization may require supervision, signature, or referral by any other health care provider as a condition of reimbursement to a licensed midwife whose services are provided pursuant to § 27-41-5(a)(6)(ii), except when the requirements are also applicable to other categories of health care providers. No health maintenance organization or patient may be required to pay for duplicate services actually rendered by both a licensed midwife and any other health care provider. Direct payment for licensed midwives will be contingent upon services rendered in a licensed health care facility and for services rendered in accordance with rules and regulations promulgated by the department of health; provided, that this provision shall not prohibit payment for services pursuant to § 42-62-26 or for other services reimbursed by third party payors.History of Section.P.L. 1990, ch. 168, § 4; P.L. 2002, ch. 292, § 85.
RI Gen L § 27-41-37 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-41 - Health Maintenance Organizations|Section 27-41-37 - Discontinuance of coverage - Chronic disabilities.

§ 27-41-37. Discontinuance of coverage — Chronic disabilities.No health maintenance organization subject to the provisions of this chapter shall discontinue reimbursement for or providing services for covered health care services of chronic disabilities, unless the patient has exhausted benefits to which he or she is entitled under the basic subscriber agreement, or unless it is at the end of the open enrollment period; provided notice of the discontinuation of reimbursement for the services is sent to subscribers who have been reimbursed for or utilized those services in the past three (3) years. The notice shall be mailed at least sixty (60) days prior to the beginning of the open enrollment period. For the purposes of this section "chronic disability" means an impairment or illness that is likely to continue indefinitely.History of Section.P.L. 1991, ch. 127, § 4.
RI Gen L § 27-41-38 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-41 - Health Maintenance Organizations|Section 27-41-38 - Drug coverage.

§ 27-41-38. Drug coverage.No health maintenance organization that provides coverage for prescription drugs under a group plan master contract delivered, issued for delivery, or renewed in this state may require any person covered under the contract to obtain prescription drugs from a mail order pharmacy as a condition of obtaining benefits for the drugs.History of Section.P.L. 1991, ch. 345, § 4; P.L. 2002, ch. 292, § 85.
RI Gen L § 27-41-38.1 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-41 - Health Maintenance Organizations|Section 27-41-38.1 - Medication synchronization.

§ 27-41-38.1. 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, § 4; P.L. 2016, ch. 196, § 4.
RI Gen L § 27-41-39 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-41 - Health Maintenance Organizations|Section 27-41-39 - Certified registered nurse practitioners and psychiatric and mental health nurse clinical specialists.

§ 27-41-39. Certified registered nurse practitioners and psychiatric and mental health nurse clinical specialists.(a) Every individual or group policy or contract delivered, issued for delivery, or renewed by a health maintenance organization in this state shall provide coverage for the services of certified registered nurse practitioners, practicing collaboratively and psychiatric and mental health nurse clinical specialists to subscribers, if those services are within the certified registered nurse practitioner's or psychiatric and mental health nurse clinical specialist's area of professional competence as established by education and certification, and are currently reimbursed when rendered by any other healthcare provider. No health maintenance organization may be required to pay for duplicative services actually rendered by a certified nurse practitioner and any other healthcare provider.(b) Nothing in this chapter shall preclude the conducting of managed care reviews and medical necessity reviews by an insurer or hospital or medical service corporation or health maintenance organization.(c) Every individual or group policy or contract delivered, issued for delivery, or renewed by a health maintenance organization in this state shall provide coverage for certified registered nurse practitioners to provide primary care, intermediate, home, long-term and inpatient care as primary care providers, when said certified registered nurse practitioner is a participating provider, consistent with, and practicing within, the scope of his/her professional license.(d) Notwithstanding any law to the contrary, all insurers, nonprofit medical service corporations, nonprofit hospital service corporations and health maintenance organizations shall provide subscribers with an opportunity to select a certified registered nurse practitioner, who is a participating provider, as a primary care provider.(e) Notwithstanding any law to the contrary, all insurers, nonprofit medical service corporations, nonprofit hospital service corporations and health maintenance organizations shall insure that all participating primary care provider certified registered nurse practitioners are included on any publicly accessible list of participating providers for the respective organization.History of Section.P.L. 1991, ch. 361, § 4; P.L. 1994, ch. 90, § 3; P.L. 2002, ch. 292, § 85; P.L. 2009, ch. 351, § 3; P.L. 2009, ch. 352, § 3.