§ 27-18-34 - Health insurance contracts – Certified registered nurse practitioners and psychiatric and mental health nurse clinical specialists. - Rhode Island Statutes

SECTION 27-18-34

   § 27-18-34  Health insurance contracts– Certified registered nurse practitioners and psychiatric and mentalhealth nurse clinical specialists. – (a) Every health insurance contract, plan, or policy delivered, issued fordelivery, or renewed in this state shall provide coverage for the services of acertified registered nurse practitioner, practicing collaboratively, or in theemploy of a physician licensed under chapter 37 of title 5, and psychiatric andmental health nurse clinical specialists, to subscribers if the services arewithin the certified registered nurse practitioner's or psychiatric and mentalhealth nurse clinical specialist's area of professional competence asestablished by education and certification, and are currently reimbursed whenrendered by any other licensed health care provider. No insurer or hospital,medical service corporation, or health maintenance organization may require thesignature, by any other health care provider as a condition of reimbursement.No insurer or hospital, medical service corporation, or health maintenanceorganization may be required to pay for duplicative services actually renderedby both a certified registered nurse practitioner and any other health careprovider.

   (b) Nothing in this chapter shall preclude the conducting ofmanaged care reviews and medical necessity reviews by an insurer or hospital ormedical service corporation or health maintenance organization.

   (c) Every health insurance contract, plan, or policydelivered, issued for delivery, or renewed in this state shall provide coveragefor 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/her professionallicense.

   (d) Notwithstanding any law to the contrary, all insurers,nonprofit medical service corporations, nonprofit hospital service corporationsand health maintenance organizations shall provide subscribers with anopportunity to select a certified registered nurse practitioner, who is aparticipating provider, as a primary care provider.

   (e) Notwithstanding any law to the contrary, all insurers,nonprofit medical service corporations, nonprofit hospital service corporationsand health maintenance organizations shall insure that all participatingprimary care provider certified registered nurse practitioners are included onany publicly accessible list of participating providers for the respectiveorganization.

   (f) This section shall not apply to insurance coverageproviding benefits for; (1) Hospital confinement indemnity; (2) Disabilityincome: (3) Accident only; (4) Long-term care; (5) Medicare supplement; (6)Limited benefit health; (7) Specified disease indemnity; (8) Sickness or bodilyinjury or death by accident or both; and (9) Other limited benefit policies.