reglab/housing_qa huggingface dataset:
RI Gen L § 27-20-27.2 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-20 - Nonprofit Medical Service Corporations|Section 27-20-27.2 - Conditions of coverage. [Repealed on effective date of § 27-20-64.]

§ 27-20-27.2. Conditions of coverage. [Repealed on effective date of § 27-20-64.]As provided in § 27-20-27, coverage shall be extended to new cancer therapies still under investigation when the following circumstances are present:(1) Treatment is being provided pursuant to a phase II, III or IV clinical trial which has been approved by the National Institutes of Health (NIH) in cooperation with the National Cancer Institute (NCI), community clinical oncology programs; the Food and Drug Administration in the form of an investigational new drug (IND) exemption; the Department of Veterans' Affairs; or a qualified nongovernmental research entity as identified in the guidelines for NCI cancer center support grants;(2) The proposed therapy has been reviewed and approved by a qualified institutional review board (IRB);(3) The facility and personnel providing the treatment are capable of doing so by virtue of their experience, training, and volume of patients treated to maintain expertise;(4) The patients receiving the investigational treatment meet all protocol requirements;(5) There is no clearly superior, noninvestigational alternative to the protocol treatment;(6) The available clinical or preclinical data provide a reasonable expectation that the protocol treatment will be at least as efficacious as the noninvestigational alternative; and(7) The coverage of new cancer therapy treatment provided pursuant to a phase II clinical trial is not required for only that portion of that treatment that is provided as part of the phase II clinical trial and is funded by a national agency, such as the National Cancer Institute, the Veteran's Administration, the Department of Defense, or funded by commercial organizations such as the biotechnical and/or pharmaceutical industry or manufacturers of medical devices. Any portions of a phase II trial which are customarily funded by government, biotechnical and/or pharmaceutical and/or medical device industry sources in Rhode Island or in other states shall continue to be funded in Rhode Island and coverage pursuant to this section supplements, does not supplant customary funding.History of Section.P.L. 1994, ch. 301, § 3; P.L. 1997, ch. 51, §§ 3, 7; P.L. 1997, ch. 92, §§ 3, 7; P.L. 1999, ch. 134, § 3.
RI Gen L § 27-20-27.3 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-20 - Nonprofit Medical Service Corporations|Section 27-20-27.3 - Managed care. [Repealed on effective date of § 27-20-64.]

§ 27-20-27.3. Managed care. [Repealed on effective date of § 27-20-64.]Nothing in this chapter shall preclude the conducting of managed care reviews and medical necessity reviews by an insurer, hospital or medical service corporation, or health maintenance organization. A nonprofit medical service corporation may, as a condition of coverage, require its members to obtain new cancer therapies still under investigation as outlined in this chapter from providers and facilities designated by the nonprofit medical service corporation to render these new cancer therapies.History of Section.P.L. 1994, ch. 301, § 3; P.L. 1998, ch. 441, § 21.
RI Gen L § 27-20-28 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-20 - Nonprofit Medical Service Corporations|Section 27-20-28 - Repealed.

§ 27-20-28. Repealed.
RI Gen L § 27-20-29.1 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-20 - Nonprofit Medical Service Corporations|Section 27-20-29.1 - Insurance coverage for mastectomy hospital stays.

§ 27-20-29.1. Insurance coverage for mastectomy hospital stays.(a) The Rhode Island General Assembly recognizes that breast cancer is a unique illness with both a physical and emotional impact on patients. Every individual or group hospital or medical services plan contract delivered, issued for delivery, or renewed in this state shall provide coverage for a minimum forty-eight (48) hour time period in a hospital after the surgical procedures known as a mastectomy, and a minimum twenty-four (24) hours after an axillary node dissection. Any decision to shorten this minimum coverage shall be made by the attending physician in consultation with and upon agreement by the patient. If the patient participates in an early discharge, defined as in-patient care following a mastectomy that is less than forty-eight hours and in-patient care following an axillary node dissection that is less than twenty-four (24) hours, coverage shall include a minimum of one home visit conducted by a physician or registered nurse.(b) Any subscriber 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 23 of title 17.12. 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.(c) All plans subject to this section shall provide notice to each enrollee:(1) In the next mass mailing made by the plan to the employee; or(2) As part of any informational packet sent to the enrollee.History of Section.P.L. 1997, ch. 24, § 3; P.L. 1997, ch. 25, § 3; P.L. 2002, ch. 292, § 39.
RI Gen L § 27-20-30 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-20 - Nonprofit Medical Service Corporations|Section 27-20-30 - Diabetes treatment.

§ 27-20-30. Diabetes treatment.(a) Every 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, shall include coverage for the following equipment and supplies for the treatment of insulin treated diabetes, non-insulin treated diabetes, and gestational diabetes when medically appropriate and prescribed by a physician: blood glucose monitors and blood glucose monitors for the legally blind, test strips for glucose monitors and/or visual reading, insulin, injection aids, cartridges for the legally blind, syringes, insulin pumps, and appurtenances to the pumps, insulin infusion devices, and oral agents for controlling blood sugar and therapeutic/molded shoes for the prevention of amputation. Upon the approval of new or improved diabetes equipment and supplies by the Food and Drug Administration, all policies governed by this chapter shall guarantee coverage of new diabetes equipment and supplies when medically appropriate and prescribed by a physician. These policies shall also include coverage, when medically necessary, for diabetes self-management education to ensure that persons with diabetes are instructed in the self-management and treatment of their diabetes, including information on the nutritional management of diabetes. The coverage for self-management education and education relating to medical nutrition therapy shall be limited to medically necessary visits upon the diagnosis of diabetes, where a physician diagnosis a significant change in the patient's symptoms or conditions which necessitate changes in a patient's self-management, or where reeducation or refresher training is necessary. This education, when medically necessary and prescribed by a physician, may be provided only by the physician or, upon his or her referral, to an appropriately licensed and certified health care provider, and may be conducted in group settings. Coverage for self-management education and education relating to medical nutrition therapy shall also include home visits when medically necessary.(b) Benefit plans offered by a hospital service corporation may impose copayment and/or deductibles for the benefits mandated by this chapter, however, in no instance shall the copayment or deductible amount be greater than the copayment or deductible amount imposed for other supplies, equipment, or physician office visits. Benefits for services under this chapter shall be reimbursed in accordance with the respective principles and mechanisms of reimbursement for each insurer, hospital, or medical service corporation, or health maintenance organization.History of Section.P.L. 1996, ch. 106, § 3; P.L. 2002, ch. 292, § 39.
RI Gen L § 27-20-31 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-20 - Nonprofit Medical Service Corporations|Section 27-20-31 - Primary and preventive obstetric and gynecological care.

§ 27-20-31. Primary and preventive obstetric and gynecological care.Any insurer or nonprofit health service plan that provides obstetric and gynecological care for issuance or delivery in the state to any group or individual on an expense-incurred basis, including a health maintenance organization shall permit a woman to receive an annual visit to an in-network obstetrician/gynecologist for routine gynecological care without requiring the woman to first obtain a referral from a primary care provider.History of Section.P.L. 1997, ch. 166, § 3; P.L. 1997, ch. 174, § 3.
RI Gen L § 27-20-32 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-20 - Nonprofit Medical Service Corporations|Section 27-20-32 - Whistleblowers protection.

§ 27-20-32. Whistleblowers protection.No nonprofit medical service corporation 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, § 3.
RI Gen L § 27-20-33 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-20 - Nonprofit Medical Service Corporations|Section 27-20-33 - Penalties and remedies.

§ 27-20-33. Penalties and remedies.(a) Any person, firm, corporation, association or other legal entity who or which shall violate the provisions of § 27-20-32 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 a 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, § 3.
RI Gen L § 27-20-34 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-20 - Nonprofit Medical Service Corporations|Section 27-20-34 - Additional relief and damages - Reinstatement.

§ 27-20-34. Additional relief and damages — Reinstatement.(a) A physician or other medical provider who alleges a violation of this chapter 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 chapter shall order, as the court considers appropriate, reinstatement of the provider agreement.History of Section.P.L. 1997, ch. 167, § 3.
RI Gen L § 27-20-35 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-20 - Nonprofit Medical Service Corporations|Section 27-20-35 - Third-party reimbursement for services of certain healthcare workers.

§ 27-20-35. Third-party reimbursement for services of certain healthcare workers.(a) Every individual or group health insurance contract, plan, or policy 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 nonprofit medical service corporation 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 nonprofit medical service corporation as to which certified registered nurse anesthetists it shall contract with. Reimbursement shall be provided according to the respective principles and policies of the nonprofit medical service corporation; provided, that no nonprofit medical service corporation 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 nonprofit medical service corporation 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, § 3; P.L. 1997, ch. 365, § 3; P.L. 2002, ch. 292, § 39; P.L. 2015, ch. 205, § 3; P.L. 2015, ch. 223, § 3.
RI Gen L § 27-20-35.1 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-20 - Nonprofit Medical Service Corporations|Section 27-20-35.1 - Third party reimbursement for services of registered nurse first assistants.

§ 27-20-35.1. Third party reimbursement for services of registered nurse first assistants.(a) Every individual or group health insurance contract, plan or policy delivered, issued or renewed by an insurer or nonprofit or for profit 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, provided, 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 of 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 nonprofit hospital service corporation has an alternative contractual relationship to fund the services of a registered nurse first assistant.(b) It remains within the sole discretion of the nonprofit medical service corporation as to which registered nurse first assistant in surgery it contracts with. Reimbursement is provided according to the respective principles and policies of the nonprofit medical service corporation: provided, that no nonprofit medical service corporation is 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 precludes the nonprofit medical service corporations from conducting managed care, medical necessity or utilization review.History of Section.P.L. 1999, ch. 509, § 3; P.L. 2002, ch. 292, § 39.
RI Gen L § 27-20-36 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-20 - Nonprofit Medical Service Corporations|Section 27-20-36 - Human leukocyte antigen testing.

§ 27-20-36. Human leukocyte antigen testing.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. 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.History of Section.P.L. 1998, ch. 8, § 3; P.L. 1998, ch. 9, § 3; P.L. 2002, ch. 292, § 39.
RI Gen L § 27-20-37 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-20 - Nonprofit Medical Service Corporations|Section 27-20-37 - Drug coverage.

§ 27-20-37. Drug coverage.(a) Any nonprofit medical-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 medical-service corporation's formulary if he or she believes that the prescription of the non-formulary medication is medically necessary. A nonprofit medical-service corporation shall be required to provide coverage for a non-formulary medication only when the non-formulary medication meets the nonprofit medical-service corporation's medical-exception criteria for the coverage of that medication.(b) A nonprofit medical-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 medical-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 medical-service corporation may immediately remove from its plan formularies covered prescription drugs deemed unsafe by the nonprofit medical-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, § 3; P.L. 2016, ch. 541, § 3; P.L. 2017, ch. 274, § 3; P.L. 2017, ch. 361, § 3.
RI Gen L § 27-20-38 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-20 - Nonprofit Medical Service Corporations|Section 27-20-38 - Restricted annual rate payments prohibited.

§ 27-20-38. 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 permissible by law.History of Section.P.L. 1998, ch. 352, § 3.