reglab/statecodes huggingface dataset:
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-17. - Additional benefits.

§ 27-19-17. Additional benefits.
Notwithstanding the provisions of this chapter, any nonprofit hospital service corporation organized under this chapter may contract with any of its subscribers for coverage or benefits for medical services as may from time to time be provided under any plan adopted by the corporation. “Subscribers” as used in this chapter includes, in addition to those set forth in § 27-19-1, persons contracting with the corporation for coverage or benefits for medical services. “Medical services” as used in this chapter means professional services rendered by physicians, dentists, podiatrists, or other providers of health services for any medical, dental, surgical, and other health services as may lawfully be rendered by them to subscribers; the term includes appliances, drugs, medicines, supplies, and nursing care necessary in connection with those services, or the expense indemnity for those services, appliances, drugs, medicines, supplies, and care, as may be specified in any nonprofit medical service plan.
History of Section.
P.L. 1978, ch. 64, § 2; P.L. 1998, ch. 441, § 20.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-18. - Coverage for adoptive children.

§ 27-19-18. Coverage for adoptive children.
Subscribers to any nonprofit hospital service plan who have satisfied the continuous membership requirements of the plan, and who adopt children under the guardianship and custody of the director of the department of children, youth and families, shall be afforded coverage under the plan for any adopted child without any waiting period, notwithstanding the fact that the adopted child may have any preexisting medical condition.
History of Section.
P.L. 1982, ch. 183, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-19. - Changing coverage.

§ 27-19-19. Changing coverage.
No group health insurer subject to the provisions of this chapter shall change contract provisions as specified in the group plan master contract during the term of that contract without prior written agreement of the employer, except for changes mandated under state or federal legislative enactment and changes resulting from a labor/management collective bargaining agreement, or changes necessary to meet insurance regulations promulgated by the department of business regulation.
History of Section.
P.L. 1988, ch. 384, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-20. - Mammograms and pap smears — Coverage mandated. [Effective until January 1, 2024.]

§ 27-19-20. Mammograms and pap smears — Coverage mandated. [Effective until January 1, 2024.]
(a)
Subscribers to any nonprofit hospital service plan shall be afforded coverage under the 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 nonprofit hospital service plan shall be afforded coverage for two (2) 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, § 1; P.L. 2005, ch. 405, § 2.
§ 27-19-20. Mammograms and pap smears — Coverage mandated. [Effective January 1, 2024.]
(a)
Subscribers to any nonprofit hospital service plan shall be afforded coverage under the 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 nonprofit hospital service plan shall be afforded coverage for:
(1)
Two (2) 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; and
(2)
Any screening deemed medically necessary for proper breast cancer screening in accordance with applicable American College of Radiology guidelines including, but not limited to, magnetic resonance imaging, ultrasound, or molecular breast imaging for any person who has received notice pursuant to § 23-12.9-2 of the existence of dense breast tissue.
History of Section.
P.L. 1988, ch. 532, § 1; P.L. 2005, ch. 405, § 2; P.L. 2023, ch. 331, § 2, effective January 1, 2024; P.L. 2023, ch. 332, § 2, effective January 1, 2024.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-21. - Mammograms — Quality assurance standards.

§ 27-19-21. Mammograms — Quality assurance standards.
A mammogram eligible for reimbursement under § 27-19-20 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, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-22. - Pap smears — Quality assurance standards.

§ 27-19-22. Pap smears — Quality assurance standards.
A pap smear eligible for reimbursement under § 27-19-20 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 Healthcare Organizations or the American Osteopathic Association at the time the pap smear is processed.
History of Section.
P.L. 1989, ch. 217, § 9.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-23. - Coverage for infertility.

§ 27-19-23. Coverage for infertility.
(a)
Any nonprofit hospital service contract, plan, or insurance policies delivered, issued for delivery, or renewed in this state, except contracts 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 nonprofit hospital service corporation 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 a 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 presumably 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, § 2; P.L. 2002, ch. 292, § 37; P.L. 2006, ch. 246, art. 34, § 2; P.L. 2007, ch. 411, § 2; P.L. 2017, ch. 132, § 2; P.L. 2017, ch. 150, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-23.1. - Insurance coverage for postpartum hospital stays.

§ 27-19-23.1. Insurance coverage for postpartum hospital stays.
(a)
Every individual or group hospital or medical services plan contract delivered, issued for delivery, as 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 for a Cesarean section for a mother and her newly born child. Any decision to shorten these minimum coverages shall be made by the attending healthcare 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) hours 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 above guidelines.
(b)
For the purposes of this section, “attending healthcare provider” includes the attending obstetrician, pediatrician, family practitioner, general practitioner, or certified nurse midwife attending the mother and newly born child.
(c)
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.
History of Section.
P.L. 1996, ch. 246, § 3; P.L. 1996, ch. 260, § 3; P.L. 2002, ch. 292, § 37.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-24. - Nonprofit hospital service corporations assessment.

§ 27-19-24. Nonprofit hospital service corporations assessment.
(a)
Notwithstanding any other provisions of law, each domestic nonprofit hospital service corporation shall be charged an assessment to partially support the activities of the division of insurance in the department of business regulation.
(b)
The assessment referred to in subsection (a) of this section shall be calculated in the same manner as set forth in § 27-1-41 [repealed].
(c)
The minimum assessment charged shall be the greater of the sum determined by subsection (b) of this section or $ 1,000.
History of Section.
P.L. 1990, ch. 65, art. 29, § 2; P.L. 1993, ch. 180, § 14.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-25. - Discontinuance of coverage — Chronic disabilities.

§ 27-19-25. Discontinuance of coverage — Chronic disabilities.
No nonprofit hospital service corporation subject to the provisions of this chapter shall discontinue reimbursement for or providing services for covered healthcare 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 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, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-26. - Drug coverage.

§ 27-19-26. Drug coverage.
No group health insurer subject to the provisions of this chapter 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, § 2; P.L. 2002, ch. 292, § 37.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-26.1. - Medication synchronization.

§ 27-19-26.1. 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 has 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, § 2; P.L. 2016, ch. 196, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-27. - Certified registered nurse practitioners and psychiatric and mental health nurse clinical specialists.

§ 27-19-27. Certified registered nurse practitioners and psychiatric and mental health nurse clinical specialists.
(a)
Every health insurance contract, plan, or policy delivered, issued for delivery, or renewed in this state shall provide coverage for the services of a certified registered nurse practitioner, practicing collaboratively, or in the employ of a physician licensed under chapter 37 of title 5, and psychiatric and mental health nurse clinical specialists, to subscribers if the 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 licensed healthcare provider. No insurer or hospital or medical service corporation may require signature by any other healthcare provider as a condition of reimbursement. No insurer or hospital or medical service corporation may be required to pay for duplicative services actually rendered by both 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 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 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 or 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, § 3; P.L. 1994, ch. 90, § 2; P.L. 2002, ch. 292, § 37; P.L. 2009, ch. 351, § 2; P.L. 2009, ch. 352, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-28. - Rehabilitation, liquidation, or conservation.

§ 27-19-28. Rehabilitation, liquidation, or conservation.
(a)
Any rehabilitation, liquidation, administrative supervision, or conservation of a nonprofit hospital service corporation organized under this chapter shall be conducted under the supervision of the director of business regulation pursuant to chapters 14.1, 14.2, and 14.3 of this title. The director of business regulation may apply for an order from the superior court directing the director of business regulation to rehabilitate, liquidate, or conserve a nonprofit hospital service corporation upon any one or more of the following grounds:
(1)
That the nonprofit hospital service corporation is insolvent; for the purposes of this section, the term “insolvent” means the inability of the nonprofit hospital service corporation to meet its debts and financial obligations as they become due;
(2)
That the nonprofit hospital service corporation fails or refuses to comply with a lawful order of the director of business regulation reasonably designed to correct unsound business policies or practices which, if uncorrected, could reasonably lead to insolvency as defined in subsection (a)(1) of this section; or
(3)
That the nonprofit hospital service corporation’s financial condition is such as to render its further transaction of business hazardous to the public or its subscribers or members.
(b)
A claim by a healthcare provider shall not be asserted against any subscriber or member of the nonprofit hospital service corporation in the event of the rehabilitation, liquidation, conservation, or administrative supervision of the nonprofit hospital service corporation.
History of Section.
P.L. 1993, ch. 180, § 15.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-29. - Holding company systems.

§ 27-19-29. Holding company systems.
Except to the extent superseded by chapter 64 of this title, all of the provisions of chapter 35 of this title apply to corporations organized or licensed pursuant to this chapter.
History of Section.
P.L. 1993, ch. 180, § 15; P.L. 1998, ch. 90, § 1; P.L. 2000, ch. 178, § 3; P.L. 2000, ch. 200, § 13; P.L. 2000, ch. 229, § 13.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-29.1. - No derogation of attorney general.

§ 27-19-29.1. No derogation of attorney general.
No provision of this chapter shall derogate from the common law or statutory authority of the attorney general nor shall any provision be construed as a limitation on the common law or statutory authority of the attorney general, including the authority to investigate at any time charitable assets for the purpose of determining and ascertaining whether they are being administered in accordance with law and with its terms and purposes.
History of Section.
P.L. 1998, ch. 90, § 6.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-30. - Regulations.

§ 27-19-30. 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, § 15.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-30.1. - Health insurance rates.

§ 27-19-30.1. 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 otherwise acquires control of a nonprofit hospital service corporation organized under this chapter, a nonprofit medical service corporation organized under chapter 20 of this title, 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 otherwise 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 the 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, § 3; P.L. 1999, ch. 376, § 3.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-31. - Certified counselors in mental health and therapists in marriage and family practice.

§ 27-19-31. Certified counselors in mental health and therapists in marriage and family practice.
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 will, when deemed medically necessary by the nonprofit hospital service corporation in accordance with its standard medical management protocols and within the nonprofit hospital service corporation’s subscriber contractual benefit limits, provide coverage for the services of counselors in mental health licensed pursuant to § 5-63.2-9 and therapists in marriage and family practice licensed pursuant to § 5-63.2-10. In the case of a limited provider network, it shall remain within the sole discretion of the nonprofit hospital service corporation as to which certified counselors in mental health and certified therapists in marriage and family practice with which it shall contract. Nothing contained in this section shall require the nonprofit hospital service corporation to provide coverage other than in conjunction with a related medical illness.
History of Section.
P.L. 1994, ch. 89, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-32. - Repealed.

§ 27-19-32. Repealed.
History of Section.
P.L. 1994, ch. 301, § 2; P.L. 2002, ch. 292, § 37; Repealed by P.L. 2012, ch. 256, § 15; P.L. 2012, ch. 262, § 15, effective June 18, 2012. For comparable provisions, see § 27-19-64.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-32.1. - Repealed.

§ 27-19-32.1. Repealed.
History of Section.
P.L. 1994, ch. 301, § 2; Repealed by P.L. 2012, ch. 256, § 15; P.L. 2012, ch. 262, § 15, effective June 18, 2012. For comparable provisions, see § 27-19-64.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-32.2. - Repealed.

§ 27-19-32.2. Repealed.
History of Section.
P.L. 1994, ch. 301, § 2; P.L. 1997, ch. 51, §§ 2, 6; P.L. 1997, ch. 92, §§ 2,6; P.L. 1999, ch. 134, § 2; Repealed by P.L. 2012, ch. 256, § 15; P.L. 2012, ch. 262, § 15, effective June 18, 2012. For comparable provisions, see § 27-19-64.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-32.3. - Repealed.

§ 27-19-32.3. Repealed.
History of Section.
P.L. 1994, ch. 301, § 2; Repealed by P.L. 2012, ch. 256, § 15; P.L. 2012, ch. 262, § 15, effective June 18, 2012. For comparable provisions, see § 27-19-64.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-34.1. - Insurance coverage for mastectomy hospital stays.

§ 27-19-34.1. 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, as 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 these minimum coverages 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 otherwise 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, § 2; P.L. 1997, ch. 25, § 2; P.L. 2002, ch. 292, § 37.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-35. - Diabetes treatment.

§ 27-19-35. 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. The 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 by 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 hospital 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, § 2; P.L. 2002, ch. 292, § 37.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-36. - Primary and preventive obstetric and gynecological care.

§ 27-19-36. 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, § 2; P.L. 1997, ch. 174, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-36.1. - Hysterectomy or myomectomy treatment.

§ 27-19-36.1. 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, § 2, effective June 29, 2022; P.L. 2022, ch. 371, § 2, effective June 29, 2022.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-37. - Whistleblowers protection.

§ 27-19-37. Whistleblowers protection.
No nonprofit hospital 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, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-38. - Penalties and remedies.

§ 27-19-38. Penalties and remedies.
(a)
Any person, firm, corporation, association, or other legal entity who or that shall violate the provisions of § 27-19-37 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, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-39. - Additional relief and damages — Reinstatement.

§ 27-19-39. 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, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-40. - Third-party reimbursement for services of certain healthcare workers.

§ 27-19-40. 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 hospital 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 hospital 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 hospital service corporation; provided, that no nonprofit hospital 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 hospital 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, § 2; P.L. 1997, ch. 365, § 2; P.L. 2002, ch. 292, § 37; P.L. 2015, ch. 205, § 2; P.L. 2015, ch. 223, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-40.1. - Third-party reimbursement for services of registered nurse first assistants.

§ 27-19-40.1. 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 designated as 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 Perioperative Nursing (minimum of two (2) 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 shall remain within the sole discretion of the nonprofit hospital service corporation as to which registered nurse first assistant it shall contract with. Reimbursement shall be provided according to the respective principles and policies of the nonprofit hospital service corporation; provided, that no nonprofit hospital service corporation may be required to provide direct reimbursement, or pay for duplicative services actually rendered by a registered nurse first assistant in surgery and any other healthcare provider. Nothing contained in this section precludes the nonprofit hospital service corporations from conducting managed care, medical necessity, or utilization review.
History of Section.
P.L. 1999, ch. 509, § 2; P.L. 2002, ch. 292, § 37.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-41. - Human leukocyte antigen testing.

§ 27-19-41. 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, § 2; P.L. 1998, ch. 9, § 2; P.L. 2002, ch. 292, § 37.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-42. - Drug coverage.

§ 27-19-42. Drug coverage.
(a)
Any nonprofit hospital 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 hospital service corporation’s formulary if he or she believes that the prescription of the non-formulary medication is medically necessary. A nonprofit hospital service corporation shall be required to provide coverage for a non-formulary medication only when the non-formulary medication meets the nonprofit hospital service corporation’s medical-exception criteria for the coverage of that medication.
(b)
A nonprofit hospital 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 hospital 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 hospital service corporation may immediately remove from its plan formularies covered prescription drugs deemed unsafe by the nonprofit hospital 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, § 2; P.L. 2016, ch. 541, § 2; P.L. 2017, ch. 274, § 2; P.L. 2017, ch. 361, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-43. - Restricted annual rate payments prohibited.

§ 27-19-43. 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 otherwise permissible by law.
History of Section.
P.L. 1998, ch. 352, § 2.