reglab/statecodes huggingface dataset:
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-25.2. - Health insurance rates.

§ 27-20-25.2. Health insurance rates.
No insurance company organized as a stock or mutual corporation that 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 nonprofit hospital service corporation organized under chapter 19 of this title, a nonprofit medical service corporation organized under this chapter, or a health maintenance organization organized under chapter 41 of this title may: (1) File with any state agency for review or approval any proposed rate to be used by the company in the state, or (2) Charge to any party in the state any rate or premium, that 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 nonprofit hospital service corporation, nonprofit medical service corporation, or health maintenance organization. For any rate that is to be charged to policyholders, 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, § 4; P.L. 1999, ch. 376, § 4.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-26. - Regulations.

§ 27-20-26. Regulations.
The director of the department of business regulation may adopt reasonable rules and regulations for the implementation and administration of the provisions of this chapter.
History of Section.
P.L. 1993, ch. 180, § 17.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-27. - New cancer therapies — Under investigation. [Repealed on effective date of § 27-20-64.]

§ 27-20-27. New cancer therapies — Under investigation. [Repealed on effective date of § 27-20-64.]
Every individual or group hospital or medical expense insurance policy or individual or group hospital or medical service plan contract delivered, issued for delivery or renewed in this state shall provide coverage for new cancer therapies still under investigation as outlined in this chapter.
History of Section.
P.L. 1994, ch. 301, § 3.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-27.1. - “Reliable evidence” defined. [Repealed on effective date of § 27-20-64.]

§ 27-20-27.1. “Reliable evidence” defined. [Repealed on effective date of § 27-20-64.]
“Reliable evidence” means:
(1)
Evidence including published reports and articles in authoritative, peer reviewed medical and scientific literature;
(2)
A written informed consent used by the treating facility or by another facility studying substantially the same service; or
(3)
A written protocol or protocols used by the treating facility or protocols of another facility studying substantially the same service.
History of Section.
P.L. 1994, ch. 301, § 3.
2023 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.
2023 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.
2023 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-hour (48) 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 (48) 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 17.12 of title 23 [repealed]. No policy or plan covered under this chapter shall terminate the services, reduce capitation payment, or penalize an attending physician or other healthcare 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.
2023 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 that provides medical coverage that includes coverage for physician services in a physician’s office, and every policy that 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 diagnoses a significant change in the patient’s symptoms or conditions that necessitates 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 healthcare 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 medical service corporation may impose copayment or deductibles or both 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.
2023 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.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-31.1. - Hysterectomy or myomectomy treatment.

§ 27-20-31.1. Hysterectomy or myomectomy treatment.
Commencing January 1, 2023, any insurer or healthcare plan, nonprofit health medical service plan, or nonprofit hospital service plan that provides coverage for obstetric and gynecological care for issuance or delivery in the state to any group or individual on an expense-incurred basis, including a health plan offered by a health insurance carrier or a health maintenance organization, shall provide coverage for a hysterectomy, myomectomy and laparoscopic removal of uterine fibroids, including uterine artery embolization, intraoperative ultrasound guidance and monitoring and radiofrequency ablation.
History of Section.
P.L. 2022, ch. 370, § 3, effective June 29, 2022; P.L. 2022, ch. 371, § 3, effective June 29, 2022.
2023 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.
2023 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 that 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 that 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.
2023 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.
2023 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.
2023 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 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 registered nurse first assistant; provided, that the following conditions are met:
(1)
The registered nurse first assistant provides certain healthcare 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 medical 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 shall be 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 healthcare 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.
2023 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.
2023 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:
(1)
The written or electronic notice must contain the following information:
(i)
The name of the affected prescription drug;
(ii)
Whether the plan is removing the prescription drug from the formulary, or changing its preferred or tiered cost-sharing status; and
(iii)
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.
(2)
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.
2023 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.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-39.1. - Genetic information.

§ 27-20-39.1. Genetic information.
(a)
Except as provided in chapter 37.3 of title 5, insurance administrators, health plans, and providers shall be prohibited from releasing genetic information without prior written authorization of the individual. Written authorization shall be required for each disclosure and include to whom the disclosure is being made. An exception shall exist for those participating in research settings governed by the federal policy for the protection of human research subjects (also known as “The Common Rule”). Tests conducted purely for research are excluded from the definition, as are tests for somatic (as opposed to heritable) mutations, and testing for forensic purposes.
(b)
No individual or group health insurance contract, plan, or policy delivered, issued for delivery, or renewed in this state that provides medical coverage that includes coverage for physician services in a physician’s office, and every policy that provides major medical or similar comprehensive-type coverage excluding disability income, long-term care and insurance supplemental policies that only provide coverage for specified diseases or other supplemental policies, shall:
(1)
Use genetic information or request for genetic information or the results of genetic information or other genetic information to reject, deny, limit, cancel, refuse to renew, increase the rates of, affect the terms or conditions of, or affect a group or an individual’s health insurance policy, contract, or plan;
(2)
Request or require genetic information for the purpose of determining whether or not to issue or renew a group or individual’s health benefits coverage, to set reimbursement/copay levels, or determine covered benefits and services;
(3)
Release the results of genetic information without the prior written authorization of the individual from whom the information was obtained, except in a format by which individual identifiers are removed, encrypted, or encoded so that the identity of the individual is not disclosed. A recipient of information pursuant to this section may use or disclose the information solely to carry out the purpose for which the information was disclosed. Authorization shall be required for each redisclosure. An exception shall exist for participation in research settings governed by the federal policy for the protection of human research subjects (also known as “The Common Rule”);
(4)
Request or require information as to whether an individual has genetic information, or participated in genetic information of any kind, whether for clinical or research purposes.
(c)
For the purposes of this section, “genetic information” is information about genes, gene product, or inherited characteristics that may derive from the individual or a family member.
History of Section.
P.L. 2001, ch. 38, § 6; P.L. 2001, ch. 54, § 6; P.L. 2002, ch. 292, § 39.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-42. - Acupuncture services.

§ 27-20-42. Acupuncture services.
(a)
Every group health insurance contract, plan, or group policy delivered, issued for delivery, or renewed in this state that provides medical coverage, and every group policy that provides for treatment of persons for the prevention, cure, or correction of any illness or physical or mental condition shall provide, as an optional rider, coverage for the services of a doctor of acupuncture as a provider of acupuncture services.
(b)
For the purposes of this section:
(1)
“Coverage for the services of a doctor of acupuncture as a provider of acupuncture services” means coverage for acupuncture as defined in § 5-37.2-2(1).
(2)
“Doctor of acupuncture” means a practitioner licensed under chapter 37.2 of title 5.
(c)
It remains within the sole discretion of the nonprofit medical service corporation as to which doctor of acupuncture it contracts 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 doctor of acupuncture and any other healthcare provider. Nothing contained in this section precludes nonprofit medical service corporations from conducting managed care, medical necessity, or utilization review.
History of Section.
P.L. 1999, ch. 288, § 3.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-43. - FDA approved prescription contraceptive drugs and devices.

§ 27-20-43. FDA approved prescription contraceptive drugs and devices.
(a)
Every individual or group health insurance contract, plan, or policy that provides prescription coverage and is delivered, issued for delivery, or renewed in this state shall provide coverage for FDA approved contraceptive drugs and devices requiring a prescription. Provided, that nothing in this subsection shall be deemed to mandate or require coverage for the prescription drug RU 486.
(b)
Notwithstanding any other provision of this section, any medical service corporation may issue to a religious employer an individual or group health insurance contract, plan, or policy that excludes coverage for prescription contraceptive methods that are contrary to the religious employer’s bona fide religious tenets.
(c)
As used in this section, “religious employer” means an employer that is a “church or a qualified church-controlled organization” as defined in 26 U.S.C. § 3121.
(d)
Every religious employer that invokes the exemption provided under this section shall provide written notice to prospective enrollees prior to enrollment with the plan, listing the contraceptive healthcare services the employer refuses to cover for religious reasons.
(e)
Beginning on the first day of each plan year after April 1, 2019, every health insurance issuer offering group or individual health insurance coverage that covers prescription contraception shall not restrict reimbursement for dispensing a covered prescription contraceptive up to three hundred sixty-five (365) days at a time.
History of Section.
P.L. 2000, ch. 120, § 3; P.L. 2000, ch. 126, § 3; P.L. 2002, ch. 292, § 39; P.L. 2018, ch. 230, § 6; P.L. 2018, ch. 234, § 6.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-44. - Prostate and colorectal examinations — Coverage mandated — The Maryellen Goodwin Colorectal Cancer Screening Act.

§ 27-20-44. Prostate and colorectal examinations — Coverage mandated — The Maryellen Goodwin Colorectal Cancer Screening Act.
(a)
Subscribers to any nonprofit medical service corporation plan shall be afforded coverage under the plan for prostate and colorectal examinations and laboratory tests for cancer for any nonsymptomatic person covered under the policy or plan. The coverage required by this section shall include preventive colorectal cancer screening coverage for all colorectal cancer examinations and laboratory tests in accordance with American Cancer Society guidelines, including for colorectal cancer screening of average risk individuals, including an initial colonoscopy or other medical test or procedure for colorectal cancer screening and a follow-up colonoscopy if the results of the initial medical test or procedure are abnormal.
(b)
An insurer or the corporation may not impose cost sharing on the coverage required by subsection (a) when the services are delivered within the health insurer’s provider network.
History of Section.
P.L. 2000, ch. 125, § 3; P.L. 2000, ch. 345, § 3; P.L. 2021, ch. 7, § 4, effective April 29, 2021; P.L. 2021, ch. 8, § 4, effective April 29, 2021.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-46. - Hearing aids.

§ 27-20-46. Hearing aids.
(a)(1)
Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state on or after January 1, 2006, shall provide coverage for one thousand five hundred dollars ($1,500) per individual hearing aid, per ear, every three (3) years for anyone under the age of nineteen (19) years, and shall provide coverage for seven hundred dollars ($700) per individual hearing aid per ear, every three (3) years for anyone of the age of nineteen (19) years and older.
(2)
Every group health insurance contract or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state on or after January 1, 2006, shall provide, as an optional rider, additional hearing aid coverage. Provided, the provisions of this paragraph shall not apply to contracts, plans, or group policies subject to the small employer health insurance availability act, chapter 50 of this title.
(b)
For the purposes of this section, “hearing aid” means any nonexperimental, wearable instrument or device designed for the ear and offered for the purpose of aiding or compensating for impaired human hearing, but excluding batteries, cords, and other assistive listening devices, including, but not limited to, FM systems.
(c)
It shall remain within the sole discretion of the nonprofit medical service corporation as to the provider of hearing aids with which they choose to contract. Reimbursement shall be provided according to the respective principles and policies of the nonprofit medical service corporation. Nothing contained in this section precludes the nonprofit medical service corporation from conducting managed care, medical necessity, or utilization review.
History of Section.
P.L. 2000, ch. 461, § 3; P.L. 2004, ch. 539, § 3; P.L. 2004, ch. 550, § 3; P.L. 2005, ch. 374, § 3; P.L. 2005, ch. 395, § 3; P.L. 2006, ch. 595, § 3; P.L. 2006, ch. 614, § 3.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-48. - Mandatory coverage for certain lyme disease treatments.

§ 27-20-48. Mandatory coverage for certain lyme disease treatments.
Every individual or group hospital or medical expense insurance policy or individual or group hospital or medical services plan contract delivered, issued for delivery, or renewed in this state on or after January 1, 2004, shall provide coverage for diagnostic testing and long-term antibiotic treatment of chronic lyme disease when determined to be medically necessary and ordered by a physician acting in accordance with chapter 37.5 of title 5 entitled “lyme disease diagnosis and treatment” after making a thorough evaluation of the patient’s symptoms, diagnostic test results, and response to treatment. Treatment otherwise eligible for benefits pursuant to this section shall not be denied solely because such treatment may be characterized as unproven, experimental, or investigational in nature.
History of Section.
P.L. 2003, ch. 113, § 5; P.L. 2003, ch. 114, § 5; P.L. 2004, ch. 34, § 4; P.L. 2004, ch. 35, § 4.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-49. - Dental insurance assignment of benefits.

§ 27-20-49. Dental insurance assignment of benefits.
Every entity providing a contract of insurance as defined in this chapter shall allow, as a provision in a group or individual policy, contract, or health benefit plan for coverage of dental services, any person insured by the entity to direct, in writing, that benefits from a health benefit plan, policy, or contract, be paid directly to a dental care provider who has not contracted with the entity to provide dental services to persons covered by the entity but otherwise meets the credentialing criteria of the entity and has not previously been terminated by the entity as a participating provider. If written direction to pay is executed and written notice of the direction to pay is provided to the entity, the insuring entity shall pay the benefits directly to the dental care provider. Any efforts to modify the amount of benefits paid directly to the dental care provider under this section may include a reduction in benefits paid of no more than five percent (5%) less than the benefits paid to participating dentists. The entity paying the dentist, pursuant to a direction to pay duly executed by the subscriber, shall have the right to review the records of the dentist receiving the payment that relate exclusively to that particular subscriber/patient to determine that the service in question was rendered.
History of Section.
P.L. 2004, ch. 268, § 3; P.L. 2004, ch. 386, § 3.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-50. - Coverage for early intervention services.

§ 27-20-50. Coverage for early intervention services.
(a)
Every individual or group hospital or medical expense insurance policy or contract providing coverage for dependent children, delivered or renewed in this state on or after July 1, 2004, shall include coverage of early intervention services which coverage shall take effect no later than January 1, 2005. The coverage shall be limited to a benefit of five thousand dollars ($5,000) per dependent child per policy or calendar year and shall not be subject to deductibles and coinsurance factors. Any amount paid by an insurer under this section for a dependent child shall not be applied to any annual or lifetime maximum benefit contained in the policy or contract. For the purpose of this section, “early intervention services” means, but is not limited to: speech and language therapy; occupational therapy; physical therapy; evaluation; case management; nutrition; service plan development and review; nursing services; and assistive technology services and devices for dependents from birth to age three (3) who are certified by the department of human services as eligible for services under part C of the Individuals with Disabilities Education Act (20 U.S.C. § 1431 et seq.).
(b)
Subject to the annual limits provided in this section, insurers shall reimburse certified early intervention providers, who are designated as such by the department of human services, for early intervention services as defined in this section at rates of reimbursement equal to or greater than the prevailing integrated state/Medicaid rate for early intervention services as established by the department of human services.
(c)
This section shall not apply to insurance coverage providing benefits for: (1) Hospital confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care; (5) Medicare supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or bodily injury or death by accident or both; and (9) Other limited benefit policies.
History of Section.
P.L. 2004, ch. 595, art. 22, § 3; P.L. 2004, ch. 598, § 4; P.L. 2005, ch. 97, § 3; P.L. 2005, ch. 99, § 3; P.L. 2008, ch. 475, § 85; P.L. 2023, ch. 395, art. 1, § 5, effective December 31, 2023.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-51. - Post-payment audits.

§ 27-20-51. Post-payment audits.
(a)
Except as otherwise provided herein, any review, audit, or investigation by a nonprofit medical service corporation of a healthcare provider’s claims that results in the recoupment or set-off of funds previously paid to the healthcare provider in respect to such claims shall be completed no later than eighteen (18) months after the completed claims were initially paid, except that the period for recoupment or set-off for claims submitted by a mental health and/or substance use disorder provider, for those services, licensed by this state, and participating with the health insurer or health plan, shall be no later than twelve (12) months. This section shall not restrict any review, audit, or investigation regarding claims that are submitted fraudulently; are known, or should have been known, by the healthcare provider to be a pattern of inappropriate billing according to the standards for provider billing of their respective medical or dental specialties; are related to coordination of benefits; are duplicate claims; or are subject to any federal law or regulation that permits claims review beyond the period provided herein.
(b)
No healthcare provider shall seek reimbursement from a payer for underpayment of a claim later than eighteen (18) months from the date the first payment on the claim was made, except if the claim is the subject of an appeal properly submitted pursuant to the payer’s claims appeal policies or the claim is subject to continual claims submission.
(c)
For the purposes of this section, “healthcare provider” means an individual clinician, either in practice independently or in a group, who provides healthcare services, and any healthcare facility, as defined in § 27-20-1, including any mental health and/or substance abuse treatment facility, physician, or other licensed practitioner identified to the review agent as having primary responsibility for the care, treatment, and services rendered to a patient.
(d)
Except for those contracts where the health insurer or plan has the right to unilaterally amend the terms of the contract, the parties shall be able to negotiate contract terms that allow for different time frames than are prescribed herein.
History of Section.
P.L. 2006, ch. 86, § 3; P.L. 2006, ch. 97, § 3; P.L. 2013, ch. 251, § 3; P.L. 2013, ch. 395, § 3; P.L. 2014, ch. 201, § 3; P.L. 2014, ch. 214, § 3; P.L. 2017, ch. 368, § 3; P.L. 2017, ch. 375, § 3; P.L. 2022, ch. 157, § 3, effective June 27, 2022; P.L. 2022, ch. 158, § 3, effective June 27, 2022.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-53. - Tobacco cessation programs.

§ 27-20-53. Tobacco cessation programs.
(a)
Every individual or group health insurance contract, plan, or policy delivered, issued for delivery, or renewed in this state on or after January 1, 2010, that provides medical coverage that includes coverage for physician services in a physician’s office, and every policy that provides major medical or similar comprehensive-type coverage, shall include coverage for smoking cessation treatment, provided that if the medical coverage does not include prescription drug coverage, the contract, plan, or policy shall not be required to include coverage for FDA approved smoking cessation medications.
(b)
As used in this section, smoking cessation treatment includes the use of an over-the-counter (OTC) or prescription U.S. Food and Drug Administration (FDA) approved smoking cessation medication, when used in accordance with FDA approval, for not more than two (2) courses of medication of up to fourteen (14) weeks each, annually, when recommended and prescribed by a prescriber who holds prescriptive privileges in the state in which they are licensed, and used in combination with an annual outpatient benefit of sixteen (16) one-half (½) hour evidence-based smoking cessation counseling sessions provided by a qualified practitioner for each covered individual. Smoking cessation treatment may be redefined through regulation promulgated by the health insurance commissioner in accordance with the most current clinical practice guidelines sponsored by the United States Department of Health and Human Services or its component agencies.
(c)
Health insurance contracts, plans, or policies to which this section applies, may impose copayments and/or deductibles for the benefits mandated by this section consistent with the contracts’, plans’, or policies’ copayments and/or deductibles for physician services and medications. Nothing contained in this section shall impact the reimbursement; medical necessity or utilization review; managed care; or case management practices of these health insurance contracts, plans, or policies.
(d)
This section shall not apply to insurance coverage providing benefits for:
(1)
Hospital confinement indemnity;
(2)
Disability income;
(3)
Accident only;
(4)
Long-term care;
(5)
Medicare supplement;
(6)
Limited benefit health;
(7)
Specified disease indemnity;
(8)
Sickness or bodily injury or death by accident or both; and
(9)
Other limited benefit policies.
History of Section.
P.L. 2006, ch. 262, § 3; P.L. 2006, ch. 293, § 3; P.L. 2008, ch. 475, § 85; P.L. 2009, ch. 187, § 3; P.L. 2009, ch. 291, § 3.