2023 Rhode Island General Laws › Title 42 - State Affairs and Government › Chapter 42-7.4 - The Healthcare Services Funding Plan Act › Section 42-7.4-2. - Definitions.

§ 42-7.4-2. Definitions.
The following words and phrases as used in this chapter shall have the following meaning:
(1)(i)
“Contribution enrollee” means an individual residing in this state, with respect to whom an insurer administers, provides, pays for, insures, or covers healthcare services, unless excepted by this section.
(ii)
“Contribution enrollee” shall not include an individual whose healthcare services are paid or reimbursed by Part A or Part B of the Medicare program, a Medicare supplemental policy as defined in section 1882(g)(1) of the Social Security Act, 42 U.S.C. § 1395ss(g)(1), or Medicare managed care policy, the federal employees’ health benefit program, the Veterans’ healthcare program, the Indian health service program, or any local governmental corporation, district, or agency providing health benefits coverage on a self-insured basis;
(iii)
Delayed applicability for state employees, retirees, and dependents and not-for-profit healthcare corporations. An individual whose healthcare services are paid or reimbursed by the state of Rhode Island pursuant to chapter 12 of title 36 or a not-for-profit healthcare corporation that controls or operates hospitals licensed under chapter 17 of title 23 or a not-for-profit healthcare corporation that controls or operates hospitals licensed under chapter 17 of title 23, and facilities and programs providing rehabilitation, psychological support, and social guidance to individuals who are alcoholic, drug abusers, mentally ill, or who are persons with developmental disabilities or cognitive disabilities, such as brain injury, licensed under chapter 24 of title 40.1 shall not be treated as a “contribution enrollee” until July 1, 2016.
(2)
“Healthcare services funding contribution” means per capita amount each contributing insurer must contribute to support the programs funded by the method established under this section, with respect to each contribution enrollee; provided, however, that, with respect to an insurer that is a Medicaid managed care organization offering managed Medicaid, the healthcare funding services contribution for any contribution enrollee whose healthcare services are paid or reimbursed under Title XIX of the Social Security Act (Medicaid) shall not include the children’s health services funding requirement described in § 42-12-29.
(3)(i)
“Insurer” means all persons offering, administering, and/or insuring healthcare services, including, but not limited to:
(A)
Policies of accident and sickness insurance, as defined by chapter 18 of title 27:
(B)
Nonprofit hospital or medical-service plans, as defined by chapters 19 and 20 of title 27;
(C)
Any person whose primary function is to provide diagnostic, therapeutic, or preventive services to a defined population on the basis of a periodic premium;
(D)
All domestic, foreign, or alien insurance companies, mutual associations, and organizations;
(E)
Health maintenance organizations, as defined by chapter 41 of title 27;
(F)
All persons providing health benefits coverage on a self-insurance basis;
(G)
All third-party administrators described in chapter 20.7 of title 27; and
(H)
All persons providing health benefit coverage under Title XIX of the Social Security Act (Medicaid) as a Medicaid managed care organization offering managed Medicaid.
(ii)
“Insurer” shall not include any nonprofit dental service corporation as defined in § 27-20.1-2, nor any insurer offering only those coverages described in § 42-7.4-13.
(4)
“Person” means any individual, corporation, company, association, partnership, limited liability company, firm, state governmental corporations, districts, and agencies, joint stock associations, trusts, and the legal successor thereof.
(5)
“Secretary” means the secretary of health and human services.
History of Section.
P.L. 2014, ch. 145, art. 16, § 4; P.L. 2019, ch. 99, § 1; P.L. 2019, ch. 137, § 1; P.L. 2020, ch. 79, art. 2, § 23.