reglab/statecodes huggingface dataset:
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-41 - Health Maintenance Organizations › Section 27-41-38.1. - Medication synchronization.

§ 27-41-38.1. Medication synchronization.
(a)
An individual or group health insurance plan or policy delivered, issued for delivery, or renewed in this state on or after January 1, 2017, providing prescription drug coverage in the state, must permit and apply a prorated daily cost-sharing rate to covered prescriptions for a chronic condition that are dispensed by an in-network pharmacy for less than a thirty (30) days’ supply if the prescriber and pharmacist determine the fill or refill to be in the best interest of the patient for the management or treatment of a chronic, long-term care condition and the patient requests or agrees to less than a thirty (30) days’ supply for the purpose of synchronizing the patient’s medications and the insured’s or enrollee’s maintenance-prescription drug(s) to be synchronized meets all of the following requirements:
(1)
Is covered by the policy, certificate, or contract described in this chapter;
(2)
Is used for the management and treatment of a chronic, long-term care condition and 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, § 4; P.L. 2016, ch. 196, § 4.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-41 - Health Maintenance Organizations › Section 27-41-39. - Certified registered nurse practitioners and psychiatric and mental health nurse clinical specialists.

§ 27-41-39. Certified registered nurse practitioners and psychiatric and mental health nurse clinical specialists.
(a)
Every individual or group policy or contract delivered, issued for delivery, or renewed by a health maintenance organization in this state shall provide coverage for the services of certified registered nurse practitioners, practicing collaboratively, and psychiatric and mental health nurse clinical specialists to subscribers, if those services are within the certified registered nurse practitioner’s or psychiatric and mental health nurse clinical specialist’s area of professional competence as established by education and certification, and are currently reimbursed when rendered by any other healthcare provider. No health maintenance organization may be required to pay for duplicative services actually rendered by a certified nurse practitioner and any other healthcare provider.
(b)
Nothing in this chapter shall preclude the conducting of managed care reviews and medical necessity reviews by an insurer or hospital or medical service corporation or health maintenance organization.
(c)
Every individual or group policy or contract delivered, issued for delivery, or renewed by a health maintenance organization in this state shall provide coverage for certified registered nurse practitioners to provide primary care, intermediate, home, long-term, and inpatient care as primary care providers, when the 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, § 4; P.L. 1994, ch. 90, § 3; P.L. 2002, ch. 292, § 85; P.L. 2009, ch. 351, § 3; P.L. 2009, ch. 352, § 3.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-41 - Health Maintenance Organizations › Section 27-41-40. - Certified counselors in mental health and therapists in marriage and family practice.

§ 27-41-40. Certified counselors in mental health and therapists in marriage and family practice.
(a)
Every individual or group policy or contract delivered, issued for delivery, or renewed by a health maintenance organization in this state shall, when deemed medically necessary by the health maintenance organization in accordance with its standard medical management protocols as approved by the health department and within the 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.
(b)
It shall remain within the sole discretion of the health maintenance organization as to which certified counselors in mental health and certified therapists in marriage and family practice it shall contract with. Nothing contained in this section shall require the health maintenance organization to provide coverage other than in conjunction with a related medical illness.
History of Section.
P.L. 1994, ch. 89, § 3; P.L. 2002, ch. 292, § 85.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-41 - Health Maintenance Organizations › Section 27-41-41. - Repealed.

§ 27-41-41. Repealed.
History of Section.
P.L. 1994, ch. 301, § 4; P.L. 2002, ch. 292, § 85; Repealed by P.L. 2012, ch. 256, § 17; P.L. 2012, ch. 262, § 17, effective June 18, 2012. For comparable provisions, see § 27-41-77.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-41 - Health Maintenance Organizations › Section 27-41-41.1. - Repealed.

§ 27-41-41.1. Repealed.
History of Section.
P.L. 1994, ch. 301, § 4; Repealed by P.L. 2012, ch. 256, § 17; P.L. 2012, ch. 262, § 17, effective June 18, 2012. For comparable provisions, see § 27-41-77.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-41 - Health Maintenance Organizations › Section 27-41-41.2. - Repealed.

§ 27-41-41.2. Repealed.
History of Section.
P.L. 1994, ch. 301, § 4; P.L. 1997, ch. 51, § 4; P.L. 1997, ch. 92, § 4; P.L. 1999, ch. 134, § 4; Repealed by P.L. 2012, ch. 256, § 17; P.L. 2012, ch. 262, § 17, effective June 18, 2012. For comparable provisions, see § 27-41-77.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-41 - Health Maintenance Organizations › Section 27-41-41.3. - Repealed.

§ 27-41-41.3. Repealed.
History of Section.
P.L. 1994, ch. 301, § 4; Repealed by P.L. 2012, ch. 256, § 17; P.L. 2012, ch. 262, § 17, effective June 18, 2012. For comparable provisions, see § 27-41-77.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-41 - Health Maintenance Organizations › Section 27-41-43.1. - Insurance coverage for mastectomy hospital stays.

§ 27-41-43.1. 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) Notice.
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, § 4; P.L. 1997, ch. 25, § 4; P.L. 2002, ch. 292, § 85.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-41 - Health Maintenance Organizations › Section 27-41-44. - Diabetes treatment.

§ 27-41-44. 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 visual reading, insulin, injection aids, cartridges for the legally blind, syringes, insulin pumps and appurtenances to them, insulin infusion devices, 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 this 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. This 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 health maintenance organization 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, § 4; P.L. 2002, ch. 292, § 85.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-41 - Health Maintenance Organizations › Section 27-41-45. - Primary and preventive obstetric and gynecological care.

§ 27-41-45. 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, § 4; P.L. 1997, ch. 174, § 4.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-41 - Health Maintenance Organizations › Section 27-41-45.1. - Hysterectomy or myomectomy treatment.

§ 27-41-45.1. 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, § 4, effective June 29, 2022; P.L. 2022, ch. 371, § 4, effective June 29, 2022.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-41 - Health Maintenance Organizations › Section 27-41-46. - Whistleblowers protection.

§ 27-41-46. Whistleblowers protection.
No health maintenance organizations 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, § 4.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-41 - Health Maintenance Organizations › Section 27-41-47. - Penalties and remedies.

§ 27-41-47. Penalties and remedies.
(a)
Any person, firm, corporation, association, or other legal entity who or that shall violate the provisions of § 27-41-46 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, § 4.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-41 - Health Maintenance Organizations › Section 27-41-48. - Additional relief and damages — Reinstatement.

§ 27-41-48. Additional relief and damages — Reinstatement.
(a)
A physician or other medical provider who alleges a violation of this act 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 act shall order, as the court considers appropriate, reinstatement of the provider agreement.
History of Section.
P.L. 1997, ch. 167, § 4.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-41 - Health Maintenance Organizations › Section 27-41-49. - Third-party reimbursement for services of certain healthcare workers.

§ 27-41-49. 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, health maintenance organization, 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 health maintenance organization 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 health maintenance organization as to which certified registered nurse anesthetists it shall contract with. Reimbursement shall be provided according to the respective principles and policies of the health maintenance organization; provided, that no health maintenance organization 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 health maintenance organization 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, § 4; P.L. 1997, ch. 365, § 4; P.L. 2002, ch. 292, § 85; P.L. 2015, ch. 205, § 4; P.L. 2015, ch. 223, § 4.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-41 - Health Maintenance Organizations › Section 27-41-49.1. - Third-party reimbursement for services of registered nurse first assistants.

§ 27-41-49.1. 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, health maintenance organization, 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 such; 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 health maintenance organization has an alternative contractual relationship to fund the services of a registered nurse first assistant.
(b)
It remains within the sole discretion of the health maintenance organization as to which registered nurse first assistant it contracts with. Reimbursement shall be provided according to the respective principles and policies of the health maintenance organization; provided, that no health maintenance organization 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 health maintenance organization from conducting managed care, medical necessity, or utilization review.
History of Section.
P.L. 1999, ch. 509, § 4; P.L. 2002, ch. 292, § 85; P.L. 2023, ch. 395, art. 1, § 14, effective December 31, 2023.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-41 - Health Maintenance Organizations › Section 27-41-50. - Human leukocyte antigen testing.

§ 27-41-50. 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, as it may be amended. 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, § 4; P.L. 1998, ch. 9, § 4; P.L. 2002, ch. 292, § 85.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-41 - Health Maintenance Organizations › Section 27-41-51. - Drug coverage.

§ 27-41-51. Drug coverage.
(a)
Any health maintenance organization 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 health maintenance organization’s formulary if he or she believes that the prescription of non-formulary medication is medically necessary. A health maintenance organization shall be required to provide coverage for a non-formulary medication only when the non-formulary medication meets the health maintenance organization’s medical-exception criteria for the coverage of that medication.
(b)
A health maintenance organization’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 health maintenance organization 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 health maintenance organization may immediately remove from its plan formularies covered prescription drugs deemed unsafe by the health maintenance organization 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, § 5; P.L. 2016, ch. 541, § 5; P.L. 2017, ch. 274, § 5; P.L. 2017, ch. 361, § 5.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-41 - Health Maintenance Organizations › Section 27-41-52. - Restricted annual rate payments prohibited.

§ 27-41-52. 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, § 4.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-41 - Health Maintenance Organizations › Section 27-41-53.1. - Genetic information.

§ 27-41-53.1. 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 an 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 re-disclosure. 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, § 8; P.L. 2001, ch. 54, § 8; P.L. 2002, ch. 292, § 85.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-41 - Health Maintenance Organizations › Section 27-41-54. - Disassociation prohibited.

§ 27-41-54. Disassociation prohibited.
Notwithstanding any provision of the general or public laws to the contrary, no individual or group health insurance contract, plan, or policy delivered, issued for delivery, or renewed in this state that provides medical coverage for physician services in a physician’s office, and no policy that provides major medical or similar comprehensive-type coverage for specified diseases or other supplemental policies, shall prohibit a medical provider from ceasing an association with and participation in one health maintenance organization and associating and participating with another health maintenance organization doing business in this state.
History of Section.
P.L. 1998, ch. 460, § 1; P.L. 2002, ch. 292, § 85.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-41 - Health Maintenance Organizations › Section 27-41-57. - Acupuncture services.

§ 27-41-57. 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 health maintenance organization as to which doctor of acupuncture it contracts with. Reimbursement shall be provided according to the respective principles and policies of the health maintenance organization; provided, that no health maintenance organization is required to pay for duplicative services actually rendered by a doctor of acupuncture and any other healthcare provider. Nothing contained in this section precludes the health maintenance organization from conducting managed care, medical necessity, or utilization review.
History of Section.
P.L. 1999, ch. 288, § 4.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-41 - Health Maintenance Organizations › Section 27-41-58. - Prohibition against requiring indemnification from dentists.

§ 27-41-58. Prohibition against requiring indemnification from dentists.
No contract between a health maintenance organization (HMO) and a dentist containing provisions for the provision of services to patients may require that the dentist indemnify or hold harmless the health maintenance organization for any expenses and liabilities, including, without limitation, judgments, settlements, attorneys’ fees, court costs, and any associated charges, incurred in connection with any claim or action brought against the HMO based on the HMO’s management decisions, or utilization review provisions for any patient.
History of Section.
P.L. 1999, ch. 481, § 5.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-41 - Health Maintenance Organizations › Section 27-41-59. - FDA approved prescription contraceptive drugs and devices.

§ 27-41-59. 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 health maintenance 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, § 4; P.L. 2000, ch. 126, § 4; P.L. 2002, ch. 292, § 85; P.L. 2018, ch. 230, § 8; P.L. 2018, ch. 234, § 8.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-41 - Health Maintenance Organizations › Section 27-41-60. - Prostate and colorectal examinations — Coverage mandated — The Maryellen Goodwin Colorectal Cancer Screening Act.

§ 27-41-60. Prostate and colorectal examinations — Coverage mandated — The Maryellen Goodwin Colorectal Cancer Screening Act.
(a)
Subscribers to any health maintenance organization plan shall be afforded coverage under that 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 organization 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, § 4; P.L. 2000, ch. 345, § 4; P.L. 2021, ch. 7, § 5, effective April 29, 2021; P.L. 2021, ch. 8, § 5, effective April 29, 2021.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-41 - Health Maintenance Organizations › Section 27-41-62. - Temporary credentials.

§ 27-41-62. Temporary credentials.
Notwithstanding any requirements of any health maintenance organization accrediting body or organization to the contrary, each health maintenance organization licensed under this chapter may credential a provider on a conditional basis while the health maintenance organization reviews the application submitted by the provider for inclusion in the health maintenance organization network or networks.
History of Section.
P.L. 2000, ch. 346, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-41 - Health Maintenance Organizations › Section 27-41-63. - Hearing aids.

§ 27-41-63. 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 health maintenance organizations 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 health maintenance organizations. Nothing contained in this section precludes the health maintenance organizations from conducting managed care, medical necessity, or utilization review.
History of Section.
P.L. 2000, ch. 461, § 4; P.L. 2004, ch. 539, § 4; P.L. 2004, ch. 550, § 4; P.L. 2005, ch. 374, § 4; P.L. 2005, ch. 395, § 4; P.L. 2006, ch. 595, § 4; P.L. 2006, ch. 614, § 4.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-41 - Health Maintenance Organizations › Section 27-41-65. - Mandatory coverage for certain lyme disease treatments.

§ 27-41-65. Mandatory coverage for certain lyme disease treatments.
Subscribers to any health maintenance organization plan shall be afforded coverage under that plan on or after January 1, 2004, 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 the treatment may be characterized as unproven, experimental, or investigational in nature.
History of Section.
P.L. 2003, ch. 113, § 6; P.L. 2003, ch. 114, § 6; P.L. 2004, ch. 34, § 5; P.L. 2004, ch. 35, § 5.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-41 - Health Maintenance Organizations › Section 27-41-66. - Dental insurance assignment of benefits.

§ 27-41-66. Dental insurance assignment of benefits.
Every entity licensed under this chapter shall allow, as a provision of any evidence of coverage of dental services, any person covered 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 such 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, § 5; P.L. 2004, ch. 386, § 5.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-41 - Health Maintenance Organizations › Section 27-41-67. - Determination of maximum coverage limitation for prescription drug benefits.

§ 27-41-67. Determination of maximum coverage limitation for prescription drug benefits.
The calculation of subscriber maximum coverage limitations for prescription drug coverage shall be based upon the actual cost incurred by the health maintenance organization for the purchase of the covered prescription drug.
History of Section.
P.L. 2004, ch. 412, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-41 - Health Maintenance Organizations › Section 27-41-68. - Coverage for early intervention services.

§ 27-41-68. 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, § 4; P.L. 2004, ch. 598, § 5; P.L. 2005, ch. 97, § 4; P.L. 2005, ch. 99, § 4; P.L. 2008, ch. 475, § 94; P.L. 2023, ch. 395, art. 1, § 14, effective December 31, 2023.